Feasibility and adequacy of robot-assisted lymphadenectomy for renal-cell carcinoma

The role of lymph node dissection (LND) for renal-cell carcinoma (RCC) is evolving. When clinically negative, nodal disease is rare, but LND remains important in selected patients. Earlier identification of micrometastasis may become beneficial with emerging systemic agents. The ability to perform an adequate LND laparoscopically is uncertain. Open surgical data suggest a minimum of 12 nodes needed to identify most nodal metastases. Robotics may improve adequacy of laparoscopic LND. We report our results with the first reported robot-assisted LND series for RCC.

Robot-assisted LND was performed in 36 patients with RCC by a single surgeon. For right-sided tumors, LND included paracaval, retrocaval, and interaortocaval nodes, and left-sided tumors included interaortocaval and periaortic nodes.

Mean patient age was 58 years (22-79) with a mean body mass index of 32 kg/m(2) (20-54). Mean tumor size was 7.3 cm with 16 T(3) tumors, including 4 vena caval tumor thrombi. Mean time for LND was 31 minutes, and mean estimated blood loss was 74 mL with no transfusions. Discharge was postoperative day (POD) 1 in 94% and POD 2 in 6%. A mean of 13.9 nodes was obtained with 1 pN+ (2.8%) patient. Mean nodal yield from the first to second half of cases rose from 11 to 16.8 nodes (P=0.02) with 77% having a minimum of 12 nodes in the second half.

Robot-assisted LND for RCC is feasible with adequate nodal yield. Increased yield in later cases may reflect a learning curve. The positivity rate was low as expected, but higher yield was obtained than in the limited laparoscopic literature.