Lymph node involvement in renal cell carcinoma and survival chance by systematic lymphadenectomy

The value of systematic lymphadenectomy has been a matter of great controversy for a long period of time. A recently published paper of a retrospective autopsy study generally doubts its therapeutic effectiveness, arguing that positive lymph nodes are nearly always associated with distant metastases.

Between 1974 and 1993 1035 patients suffering from renal cell carcinoma with stages from cT 1 to 4, cM 0 were treated with curative intention. 51% underwent radical abdominal tumour nephrectomy with systematic lymphadenectomy (n = 531, group A). In 199 patients (19%, group B) only macroscopically suspect lymph nodes were removed surgically. All other patients underwent radical lumbar tumour nephrectomy without lymphadenectomy (n = 305, 29%, group C).

Mean age of group A was 55.5 +/- 10 years, B 60.3 +/- 11 and C 66.5 +/- 11. Median follow-up for all groups was 115 +/- 63 months. Median amount of removed lymph nodes was 18 in group A, 6 in group B and 3 in group C. N-categories for each group were pN 1: 4%, 2%, 1%; pN 2: 7%, 5%, 1%; pN 3: 3%, 2, %, 1%; pN x: 0%, 35%, 67% respectively. Group A with systematic lymphadenectomy had the least favourable tumour stage overall. Nevertheless long-term survival of this group is more favourable with 57% +/- 6 when compared to group B with 50 +/- 12% and C with 44% +/- 9%. 20 (27%) of the 75 lymph node positive patients of group A who have been followed-up for more than 5 years are still alive.

At least 4% of all patients benefit from extensive lymphadenectomy. This may only be a relatively small proven effect for the entire patient collective, but for a single lymph node positive patient this is an undoubtedly significant additional chance of survival especially when one notes that presently there is no curative adjuvant therapy.