Role of lymph node dissection in renal cell cancer

John, Nirmal Thampi; Blum, Kyle A.; Hakimi, A. Ari

doi:10.1016/j.urolonc.2018.03.006

Cited by 14 publications

(9 citation statements)

References 48 publications

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“…Given the clinical equipoise of this intervention 14 , we sought to query the National Cancer Database (NCDB) – the largest cancer registry in the United States - to examine the outcomes and practice patterns of LND in non-metastatic RCC. Thus, we aimed to investigate survival outcomes after LND for non-metastatic RCC, as well as to characterize contemporary surgical practice patterns using a population-based approach.…”

Section: Introductionmentioning

confidence: 99%

Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Farber

Rivera‐Núñez

Kim

et al. 2019

Urologic Oncology: Seminars and Original Investigations

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Purpose: Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for non-metastatic RCC and to characterize contemporary practice patterns. Materials and Methods: The National Cancer Database was queried for patients with non−metastatic RCC who underwent either partial or radical nephrectomy from 2010−2014. A total of 11,867 underwent surgery and LND. Chi square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n= 19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not. Results: Of all patients undergoing LND for RCC (n= 11,867), 5, 23, 31, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; p = 0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (p=0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (HR: 1.00; 95% CI 0.97–1.04). Conclusions: Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND.

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Section: Introductionmentioning

confidence: 99%

Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Farber

Rivera‐Núñez

Kim

et al. 2019

Urologic Oncology: Seminars and Original Investigations

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“…RPLND is performed for testicular tumor and RCC and for UTUC in the urology field 15,16 . Perioperative complications (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…RPLND is performed for testicular tumor and RCC and for UTUC in the urology field. 15,16 Perioperative complications (e.g. intraoperative vascular injury and postoperative chylous leakage) are of concern.…”

Section: Discussionmentioning

confidence: 99%

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

et al. 2022

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Objectives To describe the detailed perioperative complications and their management after retroperitoneal lymph node dissection with retroperitoneal laparoscopic radical nephroureterectomy for patients with upper tract urothelial carcinoma at three institutions. Methods Retroperitoneal lymph node dissection was performed on patients with upper tract urothelial carcinoma located at the pelvis and/or upper or middle ureter, and its template included the renal hilar and para‐aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra‐aortocaval lymph nodes (right side). The lymph nodes and kidneys were removed en bloc. The primary endpoint was postoperative complication rates, and the secondary endpoints were intraoperative findings and chylous leakage management. The associations of retroperitoneal lymph node dissection with postoperative complications were examined using logistic regression with propensity score techniques. Results Eighty‐eight (31%) and 195 (69%) patients underwent and did not undergo retroperitoneal lymph node dissection, respectively. There was no significant difference in postoperative complications and other perioperative findings in the entire cohort, except for prolonged operation time. Retroperitoneal lymph node dissection was not statistically significantly associated with total and serious complications in propensity score analyses. Postoperative chylous leakage could be conservatively managed even though it is common in patients with retroperitoneal lymph node dissection (14/88 (16%)). The incidence of chylous leakage was significantly lower in patients whose lymphatic vessels were meticulously clipped completely during retroperitoneal lymph node dissection (5.3% vs 24%; P = 0.017). Conclusion There was no association between retroperitoneal lymph node dissection with laparoscopic radical nephroureterectomy and postoperative complications. However, chylous leakage is often observed after retroperitoneal lymph node dissection and careful management is highly required. The use of clips during retroperitoneal lymph node dissection is recommended to minimize chylous leakage risk.

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“…They believe that such patients should be further stratified to guide lymph node dissection and subsequent treatment. However, lymph node dissection is not routinely performed during radical nephrectomy because renal tumors metastasize primarily through the hematologic system, and lymph node dissection does not appear to confer any survival benefit for patients (24). On the other hand, a study by the International Renal Cell Carcinoma Venous Thrombus Consortium (25) suggests that lymph node dissection can improve the survival rate of patients with positive lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients With Renal Cell Carcinoma and Venous Tumor Thrombus: A Population-Based Study

Yang

2022

Front. Surg.

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BackgroundTo provide better prognostic information for patients with renal cell carcinoma (RCC) combined with venous tumor thrombus (VTT). In turn, guide patients’ families and doctors to formulate plans for follow-up treatment and follow-up. We developed nomograms to predict cancer-specific survival (CSS) and overall survival (OS).MethodsA total of 2961 cases were included in this study. Through univariate and multivariate Cox proportional hazard regression analysis, independent risk factors affecting CSS and OS were screened out, and then a nomogram was drawn based on the screened variables.ResultsIndependent risk factors affecting CSS include: tumor size (HR = 1.05), histology (HR = 1.75), grade (HR = 1.94), N staging (HR = 2.06), and M staging (HR = 2.87). The median survival time for CSS was 106 months. Independent risk factors for OS include age (HR = 1.60), tumor size (HR = 1.04), histology (HR = 1.60), grade (HR = 1.68), N staging (HR-1.99), M staging (HR = 2.45). The median survival time for OS is 67 months.ConclusionsThe nomogram based on independent risk factors affecting CSS and OS can well predict the prognosis of renal cell carcinoma with venous tumor thrombus.

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Role of lymph node dissection in renal cell cancer

Cited by 14 publications

References 48 publications

Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients With Renal Cell Carcinoma and Venous Tumor Thrombus: A Population-Based Study

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