Regional lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with no suspected adenopathy before or during surgery?
A. Minervini et al., Regional lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with no suspected adenopathy before or during surgery?, BJU INT, 88(3), 2001, pp. 169-172
Objectives To evaluate the role of regional lymph node dissection (LND) in
a series of patients with renal cell carcinoma (RCC) with no suspicion of n
odal metastases before or during surgery.
Patients and methods A series of 167 patients with RCC, free from distant m
etastases at diagnosis, and who underwent radical nephrectomy at our hospit
al between January 1990 and October 1997, was reviewed. The mean (median. r
ange) follow-up was 51 (45, 19-112) months. Of the 167 patients, 108 underw
ent radical nephrectomy alone and 59 had radical nephrectomy with regional
LND limited to the anterior, posterior and lateral sides of the ipsilateral
great vessel, from the level of the renal pedicle to the inferior mesenter
ic artery. Of these 59 patients, 49 had no evidence of nodal metastases bef
ore or during surgery. The probability of survival was estimated by the Kap
lan-Meier method, using the log-rank test to estimate differences among lev
els of the analysed variables.
Results The overall 5-year survival was 79%; the 5-year survival rate for t
he 108 patients who underwent radical nephrectomy alone was 79% and for the
49 who underwent LND was 78%. Of the 49 patients with no suspicion of lymp
h node metastases, one (2%) was found to have histologically confirmed posi
tive nodes.
Conclusion These results suggest that there is no clinical benefit in terms
of overall outcome in undertaking regional LND in the absence of enlarged
nodes detected before or during surgery.