title: Surgical approach and the use of lymphadenectomy and adrenalectomy among patients undergoing radical nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  We assessed the influence of tumor size and surgical approach on the use of lymphadenectomy and adrenalectomy with radical nephrectomy.
  
  
  METHODS
  We evaluated patients with renal cell carcinoma (RCC) enrolled in the U.S. Kidney Cancer Study, a case-control study in the metropolitan areas of Detroit and Chicago from 2002 to 2007. We identified patients who underwent open (ORN) or laparoscopic radical nephrectomy (LRN). We used medical records and Surveillance, Epidemiology, and End Results (SEER) data to determine the proportion of patients who underwent lymphadenectomy or adrenalectomy. Bivariate analyses were performed to evaluate associations between tumor size, surgical approach, and receipt of lymphadenectomy or adrenalectomy.
  
  
  RESULTS
  We identified 730 patients who underwent ORN (427, 58%) or LRN (303, 42%) for RCC from 2002 to 2007. Among this group, 11% and 24% underwent lymphadenectomy or adrenalectomy, respectively. Lymphadenectomy was more common among patients treated from an open surgical approach (14.1% ORN vs. 5.9% LRN, P < 0.01); this difference was most pronounced for cases with tumors between 4 and 7 cm (15.9% vs. 2.9%, P = 0.01). Patients treated with ORN were also more likely to undergo adrenalectomy, with the greatest discrepancy among cases with tumors ≤ 4 cm (21.7% vs. 11.4%, P < 0.01).
  
  
  CONCLUSIONS
  Among patients undergoing radical nephrectomy for RCC, the use of lymphadenectomy and adrenalectomy is relatively uncommon and varies by tumor size and surgical approach. With an increasing number of patients with small tumors, the diffusion of laparoscopy, and the emergence of clinical trials evaluating systemic adjuvant therapies, our findings highlight important considerations for optimizing surgical management of patients with RCC.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Joanne S
authors.initials: JS
authors.lastname: Colt
authors.forename: Julie
authors.initials: J
authors.lastname: Ruterbusch
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Wong-Ho
authors.initials: WH
authors.lastname: Chow
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
mesh_terms: D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D055815:Young Adult