721 SURGICAL APPROACH AND THE USE OF LYMPHADENECTOMY AND ADRENALECTOMY FOR PATIENTS WITH RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy I1 Apr 2010721 SURGICAL APPROACH AND THE USE OF LYMPHADENECTOMY AND ADRENALECTOMY FOR PATIENTS WITH RENAL CELL CARCINOMA Christopher Filson, David Miller, Julie Ruterbusch, Joanne Colt, Wong-Ho Chow, and Kendra Schwartz Christopher FilsonChristopher Filson Ann Arbor, MI More articles by this author , David MillerDavid Miller Ann Arbor, MI More articles by this author , Julie RuterbuschJulie Ruterbusch Detroit, MI More articles by this author , Joanne ColtJoanne Colt Bethesda, MD More articles by this author , Wong-Ho ChowWong-Ho Chow Bethesda, MD More articles by this author , and Kendra SchwartzKendra Schwartz Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1209AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no standard approach to management of the adrenal gland and regional lymph nodes in patients undergoing radical nephrectomy (RN). We therefore used data from the NCI's United States Kidney Cancer Study (KCS) to evaluate variation in the use of lymphadenectomy and adrenalectomy among patients undergoing RN for renal cell carcinoma (RCC). We specifically assessed the influence of tumor size and surgical approach on use of these adjuncts to RN. METHODS We evaluated patients with RCC enrolled in the KCS, a population-based, case–control study conducted in the metropolitan areas of Detroit and Chicago from 2002-2007. During the study interval, 1,136 patients with RCC consented to both an epidemiological interview and medical record review. We identified patients who underwent open (ORN) or laparoscopic radical nephrectomy (LRN). Next, we used medical records and routinely-collected data from the Detroit SEER registry to determine the proportion of patients who underwent concurrent lymphadenectomy or adrenalectomy. We performed bivariate analyses to evaluate associations between tumor size, surgical approach, and receipt of lymphadenectomy or adrenalectomy. RESULTS We identified 730 patients who underwent ORN (427, 58%) or LRN (303, 42%) for RCC from 2002-2007. Among this group, 11% and 24% underwent lymphadenectomy or adrenalectomy, respectively. Lymphadenectomy was more common among patients treated with an open surgical approach (14.3% vs 5.3%, p<0.01); this difference was most pronounced for cases with tumors between 4-7 cm (15.9% vs 2.9%, p=0.01) (Figure). Patients treated with ORN were also more likely to undergo adrenalectomy, especially among cases with tumors ≤ 4 cm (21.7% vs. 11.4%, p<0.01). CONCLUSIONS Among contemporary patients undergoing RN for RCC, the use of lymphadenectomy and adrenalectomy is relatively uncommon and varies by tumor size and surgical approach. In an era characterized by an increasing number of patients with small tumors, diffusion of minimally-invasive surgical techniques, and emergence of potential systemic adjuvant therapies, our findings highlight several important considerations for urologists interested in optimizing the surgical management of patients with RCC. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e280-e281 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Filson Ann Arbor, MI More articles by this author David Miller Ann Arbor, MI More articles by this author Julie Ruterbusch Detroit, MI More articles by this author Joanne Colt Bethesda, MD More articles by this author Wong-Ho Chow Bethesda, MD More articles by this author Kendra Schwartz Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...