324 Postoperative volume change of contralateral kidney six month after radical nephrectomy as a predictor of renal insufficiency

Abstract

INTRODUCTION AND OBJECTIVES: The value of lymph node dissection (LND) in patients with renal cell carcinoma (RCC) still remains controversial. The lack of a proven benefit has led many urologists to reduce the indications for LND in the clinical setting. When LND is performed, there is evidence that a minimum of 12-15 nodes should be removed to achieve an adequate staging. Aim of this studywas to assess the changes in LND rate and nodal yield during radical nephrectomy (RN) during the last 3 decades in a large, multicentre European dataset. METHODS: We retrospectively evaluated the clinical information of a prospectively maintained database including 2884 patients treated with RN at three European tertiary care centres between 1983 and 2012. We assessed the change of LND rate over time by dividing patients in 6 groups according to the year of surgery (1983-7 vs. 1988-92 vs. 1993-7 vs. 1998-2002vs. 2003-7 vs. 2008-12).Weevaluated the temporal trendof the overall LND rate and that of the rate of LNDs performedwith different nodal yields ( 4 nodes and 12 nodes). The association between the number of lymph nodes (LNs) removed and the year of surgery was also assessed. RESULTS: Among 2884 patients treated with RN in the study period, 1550 (53.7%) underwent a LNDwith removal of amedian of 7 LNs (IQR 4-12). 1207 (41.9%) and 429 (14.9%) patients had 4 LNs and 12 LNs removed, respectively. Therewasa significant progressive reduction of the overall LND rate over time (80% in 1983-87 vs. 36% in 2008-12; p<0.001). The same trend was observed for the number of LNDs performedwith 4 nodes removed (69.4% in 1983-7 vs. 25.4%31.3 in 200812; p<0.001) and for those performedwith 12 nodes removed (31.3% in 1983-7 vs. 9.3% in 2008-12; p<0.001). (Figure) In all cases, a stable LND rate was observed in the last 10 years. A significant association between number of LNs removed and year of surgery was detected (p<0.001). CONCLUSIONS: The number of LNDs performed during RN has been significantly decreasing in the last 30 years, with a stable rate in the last decade. The number of LNDs performed with an adequate LN yield for staging has also been significantly decreasing, representing a potential quality of care concern.