[Method of radical transabdominal tumor nephrectomy with facultative or systemic lymph node dissection and results in...

The prognosis of 381 patients without metastases operated on renal cell carcinoma depends on the extent of the lymph node dissection. After facultative lymph node dissection (FLD) the uncorrected actuarial survival rates (SR) are 64 +/- 8% after 3 years and 50 +/- 9% after 5 years compared to 77 +/- 7% (3 years) and 60 +/- 11% (5 years) when systematic lymph node dissection (SLD) was performed. For stage I the better results in the SLD-group (80 +/- 10% 5 years SR for SLD; 67 +/- 13% 5 years SR for FLD) are partially to be explained as a staging-effect, whereas in stage II the difference (92 +/- 10% 5 years SR for SLD; 45 +/- 25% 5 years SR for FLD) is due to the higher radicality of the systematic dissection. In stage III (35 +/- 14% 5 years SR for SLD; 37 +/- 12% 5 years SR for FLD) the predominant influence of the tumor invasion in renal veins cannot be influenced by local extension of the operation. The incidence of lymph node metastases was 16% (n = 170) in the FLD and 23% (n = 211) in the SLD group. When only facultative dissection is done, 30% of lymph node metastases escape detection. Without any lymph node dissection the number of unrecognized lymphmetastases can be expected to be still higher. The controversies about the role of lymph node dissection in radical tumor nephrectomy are mainly caused by the lack of standardized criteria for operative and patho-histological staging procedures. Any conclusions drawn from comparing reports in the literature should be related to these modalities.