Editing Management of Localized and Locally Advanced Disease (section)

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#'''Enlarged lymph nodes on imaging (cN+)'''
#'''Cytoreductive surgery for metastatic disease'''
#'''Tumor size > 10 cm'''
#'''Nuclear grade 3 or 4'''
#'''Sarcomatoid component'''
#'''Tumor necrosis on imaging'''
#'''Extrarenal tumor extension'''
#'''Tumor thrombus'''
#'''Direct tumoral invasion of adjacent organs'''
* '''Regional lymphadenectomy should be considered in those patients who may have a reasonable chance of benefiting from the added surgery'''.
** Bulky lymphadenopathy carries a poor prognosis similar to metastatic disease, although surgical resection should be considered if feasible and if appropriate, given careful assessment of disease burden and patient age/comorbidities.