title: Decreasing rates of lymph node dissection during radical nephrectomy for renal cell carcinoma.
abstract: BACKGROUND
  The utility of lymph node dissection (LND) during radical nephrectomy for renal cell carcinoma (RCC) continues to be controversial, yet its use by urologists in the United States is unknown. We analyzed the incidence of and trends in LND from a large, nationally representative cancer registry.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results registry we identified 37,279 patients with RCC who underwent radical nephrectomy from 1988 to 2005. LND was defined as a surgeon removing ≥5 nodes; however, sensitivity tests were performed using cutoffs of ≥3 and ≥1 nodes. We analyzed changes in LND rates over time and used multivariable logistic regression to predict those who underwent LND.
  
  
  RESULTS
  Of the 37,279 patients with RCC, 2,463 (6.6 %) received a LND. There was a gradual decline in LND beginning in 1988 that accelerated after 1997, with the period of 1998-2005 having significantly decreased odds of LND compared with the period 1988-1997 (odds ratio [OR]: 0.65; 95 % confidence interval [95 % CI]: 0.59-0.71). This decline was driven primarily by a 63 % reduction in LND rates among localized tumors (p < .001).
  
  
  CONCLUSIONS
  There has been a significant decline in LND rates during radical nephrectomy for localized kidney cancer over the past 7 years. In contrast to prior estimates, very few urologists in the United States are removing ≥5 nodes during lymph node dissection for RCC.
authors.affiliation: Department of Urology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Lavery
authors.forename: Jonathan
authors.initials: J
authors.lastname: Brajtbord
authors.forename: David
authors.initials: D
authors.lastname: Samadi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Palese
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000639:trends*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D018426:SEER Program