Lymph node involvement in renal cell carcinoma and survival chance by systematic lymphadenectomy

Background: The value of systematic lymphadenectomy has been a matter of gi ent controversy for a long period of time. A recently published papa of a retrospective autopsy study generally doubts ifs therapeutic effectiveness, arguing that positive lymph nodes are nearly always associated with distan t metastases. Patients and Methods: Between 1974 and 1993 1035 patients suf fering from renal cell carcinoma with stages fi om cT I to 4, cM 0 were tre ated with curative intention. 51 % underwent radical abdominal tumor, nephr ectomy with systematic lymphadenectomy (n = 531, group A). In 199 patients (19 % group B) only macroscopically suspect lymph nodes were removed surgic ally. All other patients underwent radical lumbar tumour nephrectomy withou t lymphadenectomy (Iz = 305, 29 % group C). Results: Mean age of group A wa s 55,5 +/- 10 years, B 60,3 +/- 11 and C 66,5 +/- II. Median followup for a ll groups was 115 +/- 63 months. Median amount of removed lymph nodes was 1 8 in group A, 6 in group B and 3 in group C. N-categories for each group we re pN 1: 4 % 2 % I %; pN 2: 7 % 5 % 2 %;pN 3: 3 % 2 %, 1 %; pNx: 0 %, 35%, 67 % respectively. Group A with systematic lymphadenectomy had the least fa vourable tumour stage over all. Nevertheless longterm survival of this grou p is more favourable with 57 % +/- 6 when compared to group B with 50 +/- 1 2 % and C with 44 % +/- 9 %. 20 (27 %) of the 75 lymph node positive patien ts of group A who have been followed-lip Sor more than 5 years are still al ive. Conclusions: At least 4 % of all patients benefit from extensive lymph adenectomy. This may only be a relatively small proven effect for the entir e patient collective, but for a single lymph node positive patient this is an undoubtedly significant additional chance of survival especially when on e notes that presently there is no curative adjuvant therapy.