Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract.

OBJECTIVES: To determine the primary site and incidence of lymph node metastases in urothelial carcinoma of the upper urinary tract.

METHODS: From January 1989 to October 2005, we treated 181 patients with urothelial carcinoma of the upper urinary tract. The findings of the imaging studies when lymph node metastasis was diagnosed and the pathologic examination findings of the nodal specimens were analyzed. If multiple nodal metastases were present, the largest lymph node was considered the primary site.

RESULTS: Of the 181 patients, 42 (23.2%) had nodal involvement. Lymphatic metastasis was confirmed pathologically in 23 patients and 19 were clinically considered to have nodal metastasis without pathologic diagnosis because these patients died of the disease with deterioration of nodal involvement during follow-up. In tumors of the right renal pelvis, the primary metastatic sites were the right renal hilar, paracaval, and retrocaval nodes. Tumors of the upper two thirds of the right ureter primarily metastasized to the retrocaval and inter-aortocaval nodes. In tumors of the left renal pelvis, the primary sites were the left renal hilar and para-aortic nodes. Tumors of the upper two thirds of the left ureter primarily metastasized to the para-aortic nodes. Tumors of the lower ureter primarily metastasized inferiorly to the aortic bifurcation.

CONCLUSIONS: Lymphadenectomy for urothelial carcinoma of the right renal pelvis and upper two thirds of the ureter should include a relatively wide area, compared with regional lymph nodes conventionally addressed, encompassing the paracaval, retrocaval, and inter-aortocaval nodes.