LYMPHATOGENOUS SPREAD OF RENAL-CELL CARCINOMA - AN AUTOPSY STUDY

Purpose: We investigated the occurrence and extent of metastatic sprea d, especially regarding lymph nodes, of renal cell carcinoma. Material s and Methods: From 1958 to 1982, 554 cases of renal cell. carcinoma w ere diagnosed at autopsy. Clinical data and autopsy findings were reev aluated, and the occurrence of lymph node metastases was analyzed by h istological examination of retroperitoneal, mediastinal, supraclavicul ar, axillary and inguinal lymph nodes. Results: Distant metastases wer e revealed in 119 cases (21.5%), including 31 (5.6%) with single metas tases. In 88 cases (16%) renal cancer was the cause of death. Lymphato genous dissemination was detected in 80 cases of which 75 had addition al, mostly multifocal metastatic spread. Consequently lymph node metas tases restricted to the paracaval and/or para-aortic lymph nodes were noted in only 5 cases (0.9%). Conclusions: Of the 554 cases of clinica lly unrecognized renal cell carcinoma almost all with lymphatic spread had additional distant metastases. Therefore, the therapeutic effect of extensive retroperitoneal lymph node dissection in association with radical nephrectomy seems to be low. However, more limited lymph node dissection may be useful, mainly as a staging procedure.