Regional Lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with non suspected adenopathy before or during surgery?

BACKGROUND. Controversy exists regarding the role of lymphnode dissection at the time of radical nephrectomy for RCC. This study compares the outcome of patients with no enlargement of lymph nodes on CT or at the time of surgery. INTERPRETATION. Survival rates in the two groups of patients are shown in Fig. 2.4. Overall 5-year survival was 79%. A total of 108 patients underwent radical nephrectomy alone and had a 5-year survival of 79%. The 49 patients who underwent lymph node dissection in addition had a 5-year survival of 78%. Comment In this study, patients undergoing regional lymph node dissection did so “based on the preference of the surgeon involved, with no relation to apparent tumour stage, size, patient age and weight”, rather than the two groups being recruited via randomization. With a retrospective, non-randomized study with a mean follow up of only 51 months, the significance of these results is questionable. Clinically, no mention is made of the associated intra- and, more importantly, post-operative morbidity associated with the additional surgery. Only one (2%) of the 49 patients who underwent regional lymph node dissection (with no clinical or radiological suspicion of lymphadenopathy) was found to have lymph node metastases. As accepted by the authors, the only method of determining the potential therapeutic benefit and long-term prognosis of associated regional/extended lymph node dissection is by long-term results of a randomized controlled trial