title: Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection.
abstract: OBJECTIVE
  We better defined the benefits and morbidity of lymph node dissection in patients with localized renal cell carcinoma using the experience of patients treated at our institution.
  
  
  METHODS
  A retrospective cohort study was performed with outcome assessment based on the chart review of demographic, clinical and pathological data in 1,087 patients with renal cell carcinoma treated at our institution. Patients with renal cell carcinoma who did not undergo nephrectomy as part of cancer treatment, those with bilateral disease and those for whom nodal status was unknown were not included in this study. A total of 900 patients meeting these criteria who underwent nephrectomy for unilateral renal cell carcinoma at our medical center form the principal study population.
  
  
  RESULTS
  Positive lymph nodes were associated with larger, higher grade, locally advanced primary tumors that were more commonly associated with sarcomatoid features. Positive nodes were 3 to 4 times more common in patients with metastatic disease and the majority of these patients could be identified preoperatively. The survival of patients with regional lymph node involvement only was identical to that of patients with distant metastatic disease only. Patients with regional nodes and distant metastases had significantly inferior survival to those with either condition alone. In node negative cases lymph node dissection can be performed with no additional morbidity but it confers no survival advantage. In node positive cases lymph node dissection can also be performed safely but it is associated with improved survival and a trend toward an improved response to immunotherapy.
  
  
  CONCLUSIONS
  Regional lymph node dissection is unnecessary in patients with clinically negative lymph nodes since it offers extremely limited staging information and no benefit in terms of decreasing disease recurrence or improving survival. In patients with positive lymph nodes lymph node dissection is associated with improved survival when it is performed in carefully selected patients undergoing cytoreductive nephrectomy and postoperative immunotherapy. When lymph nodes are present, they should be resected when technically feasible.
authors.affiliation: Department of Urology, University of California School of Medicine, Los Angeles, California, USA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Amnon
authors.initials: A
authors.lastname: Zisman
authors.forename: Fredrick
authors.initials: F
authors.lastname: Dorey
authors.forename: Debby H
authors.initials: DH
authors.lastname: Chao
authors.forename: Ken-Ryu
authors.initials: KR
authors.lastname: Han
authors.forename: Jonathan
authors.initials: J
authors.lastname: Said
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Gitlitz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Figlin
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
mesh_terms: D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007376:Interleukin-2 / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009392:Nephrectomy; D017063:Outcome Assessment, Health Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D012044:Regression Analysis; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D007376:Interleukin-2; D011994:Recombinant Proteins