Lymph Nodes

Site/number/size/number involved/limit node/extracapsular spread.

Regional nodes: hilar, abdominal para-aortic, paracaval (ureter-intrapelvic). A regional lymphadenectomy will ordinarily include a minimum of eight lymph nodes, although it is often not performed in UK surgical practice. A few nodes may be found at the renal hilum and, occasionally, individual operatively suspicious nodes will be submitted. Separate dissection of the paraaortic and paracaval nodes gives optimal staging information in that a pNX specimen has worse 5-year survival (61%) than a pN0 nephrectomy (74%) implying inaccurate downstaging.

The surface component may be exophytic/papillary or sessile pfis pTa pfl pT2 pT3

Epithelium

Subepithelial connective tissue

Muscuiaris propria

Renal parenchyma orPeripelvicfat or Periureteric fat

Perinephric fat or adjacent structures e.g. vertebrae pT4

Epithelium

Subepithelial connective tissue

Muscuiaris propria

Renal parenchyma orPeripelvicfat or Periureteric fat

Perinephric fat or adjacent structures e.g. vertebrae

Figure 29.2. Renal pelvis and ureter carcinoma. pAfl|

Renal cell carcinoma pN0 no regional lymph node metastasis pN1 metastasis in a single regional node pN2 metastasis in more than one regional node.

Regional node metastases occur in 10-15% of cases and are associated with an adverse prognosis.

Pelvis/ureter carcinoma pN0 no regional lymph node metastasis pN1 single regional node metastasis <2cm pN2 single regional node metastasis >2 cm to 5 cm, multiple <5cm pN3 regional node metastasis >5 cm.

Regional node metastases occur in 5-10% of renal pelvic urothelial carcinomas.

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