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Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomized phase III
J H Blom1, H van Poppel, J M Marechal
1EORTC Data Center, Brussels, Belgium.
European Urology
|November 24, 1999
Summary
Complete lymph node dissection does not increase complications for renal cell cancer patients undergoing radical nephrectomy. The study found a low incidence of unsuspected lymph node metastases after staging.
Area of Science:
- Urology
- Surgical Oncology
Background:
- Radical nephrectomy is a standard treatment for renal cell cancer.
- The role of lymph node dissection in conjunction with radical nephrectomy remains debated.
Purpose of the Study:
- To evaluate the effectiveness and morbidity of complete lymph node dissection (CLND) combined with radical nephrectomy (RN) versus RN alone for nonmetastatic renal cell cancer.
Main Methods:
- A randomized phase III trial involving 772 patients with nonmetastatic, resectable renal cell cancer.
- Patients were randomized to either RN + CLND or RN alone.
- Postoperative follow-up until disease progression or death.
Main Results:
- No significant difference in complication rates between the RN + CLND group (383 patients) and the RN alone group (389 patients).
- Of 336 patients who underwent CLND, 325 (96.7%) had no lymph node metastases.
- The incidence of unsuspected lymph node metastases was low (3.3%).
Conclusions:
- Complete lymph node dissection does not add significant morbidity to radical nephrectomy for renal cell cancer.
- Preoperative staging effectively identifies patients without lymph node involvement, making extensive dissection unnecessary in most cases.