Can Retroperitoneal Lymph Node Dissection (RPLND) be feasibly performed to prolong survival in Renal Cell Carcinoma...

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• The therapeutic benefit of lymph node dissection (LND) in renal cell carcinoma (RCC) remains controversial.
• Previous studies were limited by low event rates for nodal metastases.
• This study focuses on patients with limited nodal involvement (1-2 positive nodes) to clarify survival and recurrence patterns.

Purpose of the Study:

• To compare survival outcomes and recurrence patterns between limited LND and template retroperitoneal lymph node dissection (RPLND) in RCC patients with 1-2 positive lymph nodes.
• To investigate the impact of LND extent on recurrence in the retroperitoneum.

Main Methods:

• Retrospective analysis of 45 RCC patients with 1-2 positive lymph nodes from a single institution (2000-2019).
• Patients underwent either limited LND or template RPLND.
• Kaplan-Meier analysis and univariate/multivariate analyses were used to assess survival and recurrence.

Main Results:

• A statistically significant difference in overall survival was observed between limited LND (n=23) and template RPLND (n=22) groups (P=0.04).
• Template RPLND involved resection of a median of 18 lymph nodes, compared to 4 in the limited LND group.
• Six patients undergoing limited LND experienced retroperitoneal lymph node recurrences; template RPLND showed a trend towards reduced recurrence.

Conclusions:

• Template RPLND may offer durable survival benefits for select RCC patients with limited lymph node metastasis.
• An initial template RPLND might be beneficial for a greater number of patients to prevent retroperitoneal recurrence.