[Lymphatic metastases in renal cell carcinoma. What is the value of operation and adjuvant therapy?].
OBJECTIVE
Management of organ-confined RCC is primarily surgical. 5-year survival rates of all stages improved from 40% in the 1950th to 50% in the 60th, and stagnate at 60% in recent series. Paramount use of ultrasound in modern medicine has been claimed to contribute significantly to an earlier detection of RCC thus better amenable for radical operation. Other factors may have been strategies and general hospital care. However, it remains unclear whether an extended lymph node dissection as suggested by Robson in a seminal paper in the 1960th bears any therapeutic value.


METHODS
The relevant literature including results of our institution were screened to support or to discard Robson's hypothesis that extended lymph node dissection improves treatment results for RCC.


RESULTS
Retrospective data are contradictory with older studies claiming a benefit whereas more recent studies show no difference. The only prospective randomized study (EORTC 30881) revealed no difference, not even a trend, in an initial analysis. Long-term follow-up has not been published. However, the incidence of positive lymph nodes has declined from approximately 30% at the time of Robson's studies to 3.3% in the treatment arm of EORTC 30881. Hence, the clinical importance of a lymph node dissection for RCC has at least epidemiologically strongly diminished. Adjuvant (immuno)-therapy for RCC is investigational with all studies so far showing no advantage. An authoritative study randomizing in high risk patients between adjuvant or no further treatment has not been published.


CONCLUSIONS
Lymph node dissection for RCC is diagnostic and improves pathologic staging. Morbidity associated with the procedure appears to be acceptable, but any therapeutic value remains unproven. Adjuvant therapy for N+ disease should be restricted to controlled clinical studies.
Mickisch
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D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy; D015996:Survival Rate; D016896:Treatment Outcome
Lymphknotenmetastasen beim Nierenzellkarzinom. Was bringen Operation und adjuvante Therapie?