[Improved actuarial results in the treatment of kidney cancer by systematic lymph node excision]

From January 1st 1970 to December 31th 1985, 706 nephrectomies for renal cell carcinoma have been performed by the staff of the urologic clinic of the University of Erlangen-Nürnberg. 222 nephrectomies by lumbal and 484 by transabdominal incision. The following study compares the results of two groups of patients, who all have been operated transabdominally with curative goal (this means that there was no evidence for distant metastases). The two groups differ in the character of the associated lymph node dissection. The first group consists of patients on whom we performed a systematic lymph node dissection (LAS, n = 291). The second group consists of those patients on whome we performed a facultative lymp node dissection (LAF, n = 193). In this prospective study of postoperative survival rates, significantly better results are obtained in the LAS-group. The survival rates according to the stage of the tumor (Robson-classification) show that stage I and II profit most of the extended lymph node dissection. The bad prognosis for stage IIIa patients, determinated by tumor invasion into the renal vein, will not be changed after extended lymph node dissection. Patients with positive regional lymph nodes (stage IIIb + c) have a significantly better prognosis during the first three years after nephrectomy, obviously as the result of reduce tumor volume, but the benefit does not last over a longer period as 5 years. According to our results we are convinced that the systematically extended lymph node dissection is an important curative measure in the surgical therapy of renal cell carcinoma.