Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis

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Abstract
Objective: To assess whether regional lymph node dissection could improve the prognosis of patients with metastatic renal cell carcinoma.Methods: We reviewed data on 258 patients who underwent cytoreductive nephrectomy at Memorial Sloan Kettering Cancer Center, New York, USA, some of whom received a concurrent lymph node dissection. The primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathological stage, lymphadenopathy, tumor size, modified Memorial Sloan Kettering Cancer Center criteria, site of metastatic disease and lymph node dissection. We created a logistic regression model to evaluate risk factors for node‐positive disease. Survival analyses were carried out for lymph node template (hilar vs other) and number of nodes removed (0–3, 4–7 or ≥8).Results: Of 258 patients, 177 (69%) underwent lymph node dissection, and positive nodes were found in 59 (33%). The 5‐year overall survival was 21% for patients who underwent lymph node dissection and 31% for patients who did not. No significant difference in survival was found among patients receiving or not receiving lymph node dissection. The 5‐year overall survival was 27% and 9% for negative and positive nodal status, respectively (P < 0.0005). For patients who underwent lymph node dissection, the presence of lymphadenopathy was a significant predictor of node‐positive disease (odds ratio 25.0, 95% confidence interval 9.04–69.4, P < 0.0001).Conclusions: Lymph node dissection carried out during cytoreductive nephrectomy is not associated with a survival benefit. Lymph node‐positive disease represents a poor prognostic variable; therefore, lymph node dissection should be considered as a staging procedure for clinical trials.

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