Lymph Node Sampling in Pediatric Renal Tumors: Survey of Current Practices and Impact of Education

To characterize how often and to what extent surgeons are willing to perform retroperitoneal node sampling (RPLNS) for a unilateral renal tumor, and whether they would be encouraged to change goal number of LNs after "targeted education" (TE) METHODS: A survey with selected demographic and LN sampling practice questions was distributed to practicing members of the Society of Pediatric Urology (SPU). After answering a 7-question questionnaire, participants were provided with an abstract on the adequacy of LN yield for staging. This served as the TE and then participants were asked to answer a final question on LN sampling goals.

A total of 76 (19.2%) of participants, out of 395 invitations, returned complete surveys. Cross tabulation between sampling goals before and after TE showed that among surgeons sampling 1-4 nodes, 13/24 (54.16%) would be willing to change their practice and sample ≥10 nodes. A higher proportion of participants who were already systematically surveilling 5-9 LNs would be willing to change their current practice: 30/39 (77%) would now aim for ≥10 LNs. On multivariate analysis, only willingness to sample ≥5 LNs in current practice was predictive of changing to sample ≥10 LNs after TE.

Retroperitoneal LNs are currently still under sampled by pediatric urologists operating on children and adolescents with unilateral renal tumors. TE appears to encourage change in LN sampling practices.