Role of lymphadenectomy in renal cell carcinoma

A retrospective analysis of 97 consecutive patients with renal cell carcinoma, observed between 1983 and 1989, was performed. All patients underwent radical nephrectomy followed by extensive retroperitoneal lymphadenectomy which included hilar, laterocaval/lateroaortic, and interaortocaval lymph node dissection. Lymph nodes and distant metastasis accounted for 6.2% and 7.2% of the cases respectively. A statistically significant correlation between the stage and the grade of the tumor and the frequency of lymph nodes (p < 0.01) and distant metastases (p < 0.05) was found. In patients with no lymph nodes or distant metastases, the 5-year survival rate was 100%, 79%, 68%, and 50% for stage T1, T2, T3, and T4 respectively. No statistical difference in survival between stage T1, T2, and T3 was found. The size and histological grade of the tumor significantly affected the survival rate at 5 years. In fact, < 5 cm, 5-10 cm, and > 10 cm tumors had 93%, 52%, and 65% survival rates respectively, while G1, G2, and G3 tumors had 75%, 68%, and 21% survival rates respectively. In patients with nodal metastases and distant metastases the 5-year survival rate was 25% and 0%. Survival appears to be significantly influenced by the presence of lymph node and distant metastases, while retroperitoneal lymphadenectomy does not improve the survival of patients with lymph node metastases.