1653 LYMPH NODE DISSECTION IN RENAL CELL CARCINOMA WITH RETROPERITONEAL LYMPH NODES: GOOD LOCAL CONTROL OF DISEASE, BUT UNCERTAIN SURVIVAL BENEFIT

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20101653 LYMPH NODE DISSECTION IN RENAL CELL CARCINOMA WITH RETROPERITONEAL LYMPH NODES: GOOD LOCAL CONTROL OF DISEASE, BUT UNCERTAIN SURVIVAL BENEFIT Frédéric D. Birkhaeuser, Silvan Boxler, and Urs E. Studer Frédéric D. BirkhaeuserFrédéric D. Birkhaeuser More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1456AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Benefit and curative potential of regional lymph node dissection (LND) remain controversial. We have retrospectively analyzed the outcome of patients in whom positive regional lymph nodes (LN) were removed in terms of recurrence and survival. METHODS Between 1980 and 2007 a total of 181 patients underwent radical or partial nephrectomy combined with regional lymph node dissection for RCC in our institution. Sixty-seven patients (37%) had nodal involvement (pN+) after histopathological evaluation. Twenty-nine patients with synchronous distant metastases (M1) were excluded from analysis. Nine patients were lost to follow-up. Twenty-nine patients were evaluated including 23 male (79%) and 6 female (21%). Median age was 62 years (IQR 59-68). The histopathological evaluation of the primary tumor revealed 24 clear cell (83%), 4 papillary (14%), 1 granular cell RCC (3%). Tumor stage was pT1 (40%) in 12, pT2 in 11 (40%), pT3 in 5 (17%) patients and pT4 in 1 (3%) patient. Median tumor size was 9 cm (range 2.5-21). Median number of resected LN was 4 (range 1-58), of positive LN 2 (range 1-26). In 7 patients the number of positive LN was not specified. RESULTS Median follow-up of the 29 patients was 18 months (range 0-177). There was no complication after LND requiring interventional treatment. At time of analysis 23 patients (79%) have died. Nineteen patients died of RCC. Median recurrence-free and overall survival were 7 months (range 0-73) and 18 months (range 0-177), respectively. Twenty-five patients (86%) had a recurrence. Of these patients, 22 had retroperitoneal or distant metastases, 1 local recurrence and 2 recurrence of unknown localization. Five patients (17%) were still alive, 2 of them without metastases. Median follow-up of the surviving patients was 29 months (range 18-75). One patient (4%) was lost to follow-up after 72 months without recurrence. CONCLUSIONS Regional LND in nodal positive patients achieves a good local control. Only few patients have regional relapse. Despite regional LND, patients with nodal disease of RCC have poor prognosis. Most patients will progress because of distant micrometastases. Whether LND prolongs the survival of some of these patients remains unquantifiable, but a few patients in whom positive lymph nodes were removed survived more than 5 years. Bern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e638 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frédéric D. Birkhaeuser More articles by this author Silvan Boxler More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...