PD29-04 NATIONAL UTILIZATION OF RETROPERITONEAL LYMPH NODE DISSECTION AMONG PATIENTS WITH KIDNEY CANCER AND CLINICAL LYMPHADENOPATHY UNDERGOING NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2016PD29-04 NATIONAL UTILIZATION OF RETROPERITONEAL LYMPH NODE DISSECTION AMONG PATIENTS WITH KIDNEY CANCER AND CLINICAL LYMPHADENOPATHY UNDERGOING NEPHRECTOMY Bream Matthew, Robert Abouassaly, Marc Smaldone, Alex Kutikov, Nilay Shah, Stephen Boorjian, R. Houston Thompson, Christopher Gonzalez, Hui Zhu, and Simon Kim Bream MatthewBream Matthew More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alex KutikovAlex Kutikov More articles by this author , Nilay ShahNilay Shah More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Christopher GonzalezChristopher Gonzalez More articles by this author , Hui ZhuHui Zhu More articles by this author , and Simon KimSimon Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.522AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The benefit of retroperitoneal lymph node dissection (RPLND) among patients with locally advanced kidney cancer and clinical lymphadenopathy (cN+) disease remains controversial. Several studies have suggested a therapeutic and staging benefit to performing RPLND at the time of radical nephrectomy (RN). We sought to assess temporal trends in RPLND, and to identify patient and hospital factors associated with its use among patients with non-metastatic cN+ kidney cancer. METHODS Using the National Cancer Database (NCDB), we identified patients with renal cell carcinoma (RCC) with regional lymph node metastasis but without distant metastasis (T1-4 cN1 M0) who underwent radical nephrectomy from 2001 to 2011. The primary outcome was performance of concomitant RPLND at the time of RN. Multivariable logistic regression was used to identify clinicopathologic and hospital characteristics associated with performance of RPLND at the time of RN. A two-sample t-test was used to compare the mean number of lymph nodes removed by hospital type. RESULTS Of a total 1853 patients undergoing RN for cN+ RCC, 1444 (78%) underwent RPLND and 409 (22%) did not. Time trend analysis showed an increase in the proportion of patients undergoing RPLND over time, from 77% in 2001 to 82% in 2011, p=0.001 for the overall trend. On multivariable analysis, factors associated with RPLND were private health insurance (OR: 2.22; 95% CI: 1.46-3.39, p<0.001) and Medicaid (OR: 2.08; 95% CI 1.11-3.92, p=0.02) compared to Medicare, and treatment at an academic center compared to community hospitals (OR: 1.59; 95% CI: 1.23-2.08, p<0.001). The mean number of lymph nodes removed during RPLND was higher when done at academic centers compared to community hospitals (8.1 vs. 5.0; p<0.001). CONCLUSIONS Despite the growing evidence that RPLND has a role in the surgical management of locally advanced kidney cancer in the non-metastatic setting, a fifth of patients with clinical lymph node metastasis are not receiving RPLND. Patients undergoing surgery at academic centers, or those who are primarily insured by private insurance or Medicaid, were more likely to have more aggressive surgical treatment. Centralizing surgery to high volume academic medical centers may increase the rates and yield of RPLND for RCC with lymph node metastasis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e707 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bream Matthew More articles by this author Robert Abouassaly More articles by this author Marc Smaldone More articles by this author Alex Kutikov More articles by this author Nilay Shah More articles by this author Stephen Boorjian More articles by this author R. Houston Thompson More articles by this author Christopher Gonzalez More articles by this author Hui Zhu More articles by this author Simon Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...