Results of 381 transabdominal radical nephrectomies for renal cell carcinoma with partial and complete en-bloc lymph-node dissection

Abstract

1. The prognosis of 381 patients operated on for renal cell carcinoma without distant metastases depended on the extent of radical nephrectomy along with lymphadenectomy. After partial lymph-node dissection (PLD), the uncorrected survival rates determined by the actuarial method were 64±8% after 3 years and 50±9% after 5 years compared to 77±7% (3 years) and 60±11% (5 years), when complete lymph-node dissection (CLD) was performed. 2. For stage I (pT 1+2) the better results in the CLD-group (88±10% 5-year survival rate for CLD; 67±13% 5-year survival rate for PLD) are partially explained as a staging-effect, whereas in the periorganic stage II (pT 3 a), the difference (92±10% 5-year survival rate for CLD; 45±25% 5-year survival rate for PLD) is due to the higher radicality of nephrectomy, with systematic dissection and removal of a larger area of borderline tissue. In stage III (35±14% 5-year survival rate for CLD; 37±12% 5-year survival rate for PLD), the predominant influence of macroscopic venous involvement could not be changed very much by local extension of the operation. Only 5.6% of all patients (CLD with stage III b) had positive lymph nodes alone. The whole group with positive lymph nodes (stage III b+c=22% in CLD) seemed to benefit from systematic dissection (32±19% 5-year survival rate for CLD, 11±19% 5-year survival rate for PLD; difference not significant). 3. The incidence of lymph-node metastases was 14% (N=170) in the PLD-group and 23% (N=211) in the CLD-group (stage IV included). When only partial dissection was done, 30% of the lymph-node metastases were not detected.