title: Systematic lymph node dissection in lung metastasectomy of renal cell carcinoma: an 18 years of experience.
abstract: BACKGROUND
  Pulmonary metastasectomy of renal cell carcinomas (RCC) remains controversial. Thoracic lymph node involvement (LNI) is a known prognostic factor. The aim of our analysis is to evaluate whether patients with LNI, and particularly N2 patients, should be excluded from surgical treatment.
  
  
  METHODS
  We retrospectively reviewed data from 122 patients who underwent operations at two French thoracic surgery departments between 1993 and 2011 for RCC lung metastases.
  
  
  RESULTS
  The population consisted of 38 women and 84 men; the average age at time of metastasectomy was 63.3 years (min: 43, max: 82). LNI was identified as a prognostic factor using univariate and multivariate analysis (median survival: 107 months vs. 37 months, P = 0.003; HR = 0.384 (0.179; 0.825), P = 0.01, respectively). Although differences in survival between metastases at the hilar and mediastinal locations were not significant (median survival: 74 months vs. 32 months, respectively, P = 0.75), length of survival time was associated with disease-free interval less than 12 months (median survival: 23 months vs. 94 months, P < 0.0001; HR = 3.081 (1.193; 7.957), P = 0.02).
  
  
  CONCLUSIONS
  Although LNI has an adverse effect on survival; long-term survival can be achieved in pN+ patients. Consequently, these patients should not be excluded from surgery. Systematic lymphadenectomy should be performed to obtain more accurate staging and to determine appropriate adjuvant treatment.
authors.affiliation: Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
authors.forename: S
authors.initials: S
authors.lastname: Renaud
authors.forename: P E
authors.initials: PE
authors.lastname: Falcoz
authors.forename: M
authors.initials: M
authors.lastname: Alifano
authors.forename: A
authors.initials: A
authors.lastname: Olland
authors.forename: P
authors.initials: P
authors.lastname: Magdeleinat
authors.forename: O
authors.initials: O
authors.lastname: Pagès
authors.forename: J F
authors.initials: JF
authors.lastname: Regnard
authors.forename: G
authors.initials: G
authors.lastname: Massard
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013997:Time Factors
keywords: lung metastases; lymph nodes; renal cell carcinoma