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The role of lymph node dissection in renal cell carcinoma

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Abstract

Due to the relatively heterogeneous metastatic spread of renal cell carcinoma (RCC) through both hematogenous and lymphatogenous routes, the surgical extirpation of regional lymph nodes in the treatment of RCC has long been a controversial topic. Individual risk is dependent on multiple variables including tumor stage, grade, and histologic sub-type, in addition to many others. Controversy exists over whether lymph node dissection (LND) simply provides improved staging or whether removal of pathologic nodes offers a therapeutic advantage. Herein, we evaluate the available data regarding the use of LND in the treatment of RCC. While we believe that LND may provide an opportunity for cure in a select group of patients, there are many variables to consider when determining its applicability to an individual patient.

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References

  1. Blom JH, van Poppel H, Marechal JM et al (2009) Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol 55(1):28–34

    Article  PubMed  Google Scholar 

  2. Blute ML, Leibovich BC, Cheville JC et al (2004) A protocol for performing extended lymph node dissection using primary tumor pathological features for patients treated with radical nephrectomy for clear cell renal cell carcinoma. J Urol 172(2):465–469

    Article  PubMed  Google Scholar 

  3. Vasselli JR, Yang JC, Linehan WM et al (2001) Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. J Urol 166(1):68–72

    Article  PubMed  CAS  Google Scholar 

  4. Wood DP Jr (1991) Role of lymphadenectomy in renal cell carcinoma. Urol Clin N Am 18(3):421–6

    Google Scholar 

  5. Mortensen H (1948) Transthoracic nephrectomy. J Urol 60(6):855–858

    PubMed  CAS  Google Scholar 

  6. Robson CJ, Churchill BM, Anderson W (1969) The results of radical nephrectomy for renal cell carcinoma. J Urol 101(3):297–301

    PubMed  CAS  Google Scholar 

  7. Van Poppel H (2011) Lymph node dissection is not obsolete in clinically node-negative renal cell carcinoma patients. Eur Urol 59(1):24–25

    Article  PubMed  Google Scholar 

  8. Assouad J, Riquet M, Foucault C et al (2006) Renal lymphatic drainage and thoracic duct connections: implications for cancer spread. Lymphology 39(1):26–32

    PubMed  CAS  Google Scholar 

  9. Assouad J, Riquet M, Berna P et al (2007) Intrapulmonary lymph node metastasis and renal cell carcinoma. Eur J Cardiothorac Surg 31(1):132–134

    Article  PubMed  Google Scholar 

  10. Crispen PL, Breau RH, Allmer C et al (2011) Lymph node dissection at the time of radical nephrectomy for high-risk clear cell renal cell carcinoma: indications and recommendations for surgical templates. Eur Urol 59(1):18–23

    Article  PubMed  Google Scholar 

  11. Terrone C, Cracco C, Porpiglia F et al (2006) Reassessing the current TNM lymph node staging for renal cell carcinoma. Eur Urol 49(2):324–331

    Article  PubMed  Google Scholar 

  12. Johnsen JA, Hellsten S (1997) Lymphatogenous spread of renal cell carcinoma: an autopsy study. J Urol 157(2):450–453

    Article  PubMed  CAS  Google Scholar 

  13. Herrlinger A, Schrott KM, Schott G et al (1991) What are the benefits of extended dissection of the regional renal lymph nodes in the therapy of renal cell carcinoma. J Urol 146(5):1224–1227

    PubMed  CAS  Google Scholar 

  14. Margulis V, Wood CG (2008) The role of lymph node dissection in renal cell carcinoma: the pendulum swings back. Cancer J (Sudbury, Mass) 14(5):308–314

    Article  Google Scholar 

  15. Ferrigni RG, Novicki DE (1985) Chylous ascites complicating genitourinary oncological surgery. J Urol 134(4):774–776

    PubMed  CAS  Google Scholar 

  16. Freedland SJ, Dekernion JB (2003) Role of lymphadenectomy for patients undergoing radical nephrectomy for renal cell carcinoma. Rev Urol 5(3):191–195

    PubMed  Google Scholar 

  17. Pantuck AJ, Zisman A, Dorey F et al (2003) Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 169(6):2076–2083

    Article  PubMed  Google Scholar 

  18. Chapman TN, Sharma S, Zhang S et al (2008) Laparoscopic lymph node dissection in clinically node-negative patients undergoing laparoscopic nephrectomy for renal carcinoma. Urology 71(2):287–291

    Article  PubMed  Google Scholar 

  19. Studer UE, Scherz S, Scheidegger J et al (1990) Enlargement of regional lymph nodes in renal cell carcinoma is often not due to metastases. J Urol 144(2 Pt 1):243–245

    PubMed  CAS  Google Scholar 

  20. Pantuck AJ, Zisman A, Belldegrun AS (2001) The changing natural history of renal cell carcinoma. J Urol 166(5):1611–1623

    Article  PubMed  CAS  Google Scholar 

  21. Edge SB (2010) American Joint Committee on Cancer. AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  22. Ward JF, Blute ML, Cheville JC et al (2002) The influence of pNx/pN0 grouping in a multivariate setting for outcome modeling in patients with clear cell renal cell carcinoma. J Urol 168(1):56–60

    Article  PubMed  Google Scholar 

  23. Dimashkieh HH, Lohse CM, Blute ML et al (2006) Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma. J Urol 176(5):1978–1982; discussion 82–83

    Google Scholar 

  24. Kwon T, Song C, Hong JH et al (2011) Reassessment of renal cell carcinoma lymph node staging: analysis of patterns of progression. Urology 77(2):373–378

    Article  PubMed  Google Scholar 

  25. Delacroix SE, Chapin BF, Chen JJ et al (2011) Can a durable disease free survival be achieved with surgical resection in patients with pathologic node positive renal cell carcinoma? J Urol 185(10) (in press)

  26. Terrone C, Guercio S, De Luca S et al (2003) The number of lymph nodes examined and staging accuracy in renal cell carcinoma. BJU Int 91(1):37–40

    Article  PubMed  CAS  Google Scholar 

  27. Whitson JM, Harris CR, Reese AC et al (2011) Lymphadenectomy improves survival of patients with renal cell carcinoma and nodal metastases. J Urol 185(5):1615–1620

    Google Scholar 

  28. Margulis V, Tamboli P, Matin SF et al (2008) Analysis of clinicopathologic predictors of oncologic outcome provides insight into the natural history of surgically managed papillary renal cell carcinoma. Cancer 112(7):1480–1488

    Article  PubMed  Google Scholar 

  29. Hutterer GC, Patard JJ, Perrotte P et al (2007) Patients with renal cell carcinoma nodal metastases can be accurately identified: external validation of a new nomogram. Int J Cancer 121(11):2556–2561

    Article  PubMed  CAS  Google Scholar 

  30. Thompson R (2008) Preoperative nomogram to predict positive lymph nodes during nephrectomy for renal cell carcinoma. J Urol 179(Supplement No. 4):212

    Google Scholar 

  31. Ming X, Ningshu L, Hanzhong L et al (2009) Value of frozen section analysis of enlarged lymph nodes during radical nephrectomy for renal cell carcinoma. Urology 74(2):364–368

    Article  PubMed  Google Scholar 

  32. Bex A, Vermeeren L, de Windt G et al (2010) Feasibility of sentinel node detection in renal cell carcinoma: a pilot study. Eur J Nucl Med Mol Imaging 37(6):1117–1123

    Article  PubMed  Google Scholar 

  33. Bex A, Vermeeren L, Meinhardt W et al (2010) Intraoperative sentinel node identification and sampling in clinically node-negative renal cell carcinoma: initial experience in 20 patients. World J Urol (Epub ahead of print)

  34. Karakiewicz PI, Trinh QD, Bhojani N et al (2007) Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival. Eur Urol 51(6):1616–1624

    Article  PubMed  Google Scholar 

  35. Peters PC, Brown GL (1980) The role of lymphadenectomy in the management of renal cell carcinoma. Urol Clin N Am 7(3):705–709

    CAS  Google Scholar 

  36. Boorjian SA, Crispen PL, Lohse CM et al (2008) Surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma following nephrectomy. J Urol 180(1):99–103 (discussion)

    Google Scholar 

  37. Lughezzani G, Capitanio U, Jeldres C et al (2009) Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma: a population-based perspective. Cancer 115(24):5680–5687

    Article  PubMed  Google Scholar 

  38. Pantuck AJ, Zisman A, Dorey F et al (2003) Renal cell carcinoma with retroperitoneal lymph nodes. Impact on survival and benefits of immunotherapy. Cancer 97(12):2995–3002

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    Brian F. Chapin, Scott E. Delacroix Jr. & Christopher G. Wood

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  1. Brian F. Chapin
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  2. Scott E. Delacroix Jr.
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  3. Christopher G. Wood
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Correspondence to Christopher G. Wood.

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Chapin, B.F., Delacroix, S.E. & Wood, C.G. The role of lymph node dissection in renal cell carcinoma. Int J Clin Oncol 16, 186–194 (2011). https://doi.org/10.1007/s10147-011-0241-3

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  • DOI: https://doi.org/10.1007/s10147-011-0241-3

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