[Lymphadenectomy in kidney cancer]

Metastases of renal carcinoma (RC) to lymph nodes were revealed in 121 (18.1%) patients from 667 operated on RC subjects. The frequency of lymph node involvement increases with T: T1--7.5%, T2--10.8%, T3--21.5%, T4--53.3%. In 42 patients the metastases were found only morphologically. In carcinoma of the right kidney the metastases most frequently affected paracaval and interaortocaval lymph nodes, in left kidney carcinoma para-aortal lymph nodes. Preoperative diagnosis of RC metastases to the lymph nodes is not feasible in N1, doubtful in N2 and quite possible in N3. Computed tomography is the most informative procedure as it detects lymphogenic metastases in 82% in N2 and 96% in N3. Overall 5-year survival of RC patients with lymph node metastases was 34.1% (T1N1--80%, T2N2--66.6%, T3N1--41.9%, T3N2--23.5%. All the patients with N3 died within 3 years. The authors think it necessary to perform regional and juxta-regional lymphadenectomy in any surgical intervention for RC in visually unaffected lymph nodes, in N1 and solitary N2. In multiple N2 and in N3 lymphadenectomy is useless.