Lymph Node Dissection in Radical Nephrectomy for Renal Cell Carcinoma:
Is It Necessary?

Pizzocaro, Giorgio; Piva, Luigi; Salvioni, Roberto

doi:10.1159/000474034

Cited by 15 publications

(2 citation statements)

References 7 publications

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“…This demonstrates that the group of patients benefiting from lymphadenectomy is limited but the real number is controversial. It has been calculated that only 5 to 10% of patients can theoretically benefit from it (Marshall and Powell, 1982;Pizzocaro et al, 1983). The obvious importance of nodal involvement on prognosis revealed in the present study indicates the need for a controlled evaluation of all nodal involvement before judging the indications and extensiveness of lymphadenectomy .…”

Section: Discussionmentioning

confidence: 62%

Prognostic Factors in Renal Carcinoma. An Evaluation of Operative Findings

Nurmi

1984

British Journal of Urology

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A consecutive series of 257 patients with renal carcinoma treated by radical nephrectomy is presented. The crude 5-year and 10-year survival rates for all patients were 47 and 31% respectively and for patients without distant metastases 62 and 50%. The importance of factors relating to prognosis was investigated with multivariate survival analysis. Metastases, nodal involvement and histological grade were strongly and independently associated with survival, but the influence of venous invasion was less important. When these factors are taken into consideration, direct extension, size and cell type of the tumour or sex and age of the patient give no significant additional prognostic information.

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Section: Discussionmentioning

confidence: 62%

Prognostic Factors in Renal Carcinoma. An Evaluation of Operative Findings

Nurmi

1984

British Journal of Urology

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“…Numerous studies have examined the effect of LND in the context of RCC. To date, several studies found LND or its extent at nephrectomy to be of no therapeutic value . Of these studies, a randomized trial was heavily criticized for including patients at very low risk (T1–2; 71%) of lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data

et al. 2013

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Maxine Sun and Quoc-Dien Trinh contributed equally to this study.What's known on the subject? and What does the study add?• A recent population-based analysis suggested a potential survival benefit with respect to performing lymph node dissection at nephrectomy in node-positive patients with RCC.• The findings of the present study failed to corroborate the association of a survival benefit with the performance of lymph node dissection at nephrectomy. Objective• Previous studies showed no survival benefit with respect to performing lymph node dissection (LND) at nephrectomy, whereas a recent population-based analysis suggested otherwise, although the latter relied on imputation. To reconcile the findings of that study by critically evaluating the handling of missing data. Patients and Methods• Study participants comprised patients diagnosed with non-metastatic renal cell carcinoma (RCC) of all stages who underwent LND at nephrectomy (n = 10 596).• Multivariable Cox regression models were performed to predict cancer-specific mortality (CSM), where the primary variable of interest was the extent of LND.• To examine differences in approaches with respect to handling missing data, separate analyses were performed: (i) imputed population; (ii) exclusion of patients with missing data; and (iii) inclusion of patients with missing data as a sub-category. Results• Overall, 2916 (28%) patients had missing tumour grade.• In multivariable analyses, our findings showed that increasing the extent of LND was associated with a significant protective effect on CSM in patients with pN1 after imputation (hazard ratio [HR], 0.82; P = 0.04).• By contrast, the extent of LND was no longer significantly associated with a lower risk of CSM after excluding patients with a missing tumour grade (HR, 0.83; P = 0.1) or when including patients with missing tumour grade as a subcategory (HR, 0.82; P = 0.05). Conclusions• The findings of the present study failed to corroborate the association of a survival benefit with increasing extent of LND at nephrectomy. • The different methodologies employed to account for missing data may introduce important biases.• Such considerations are non-negligible with respect to the interpretation of results for investigators who rely on administrative cohorts.

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Organ-Sparing Excision of Renal Cell Carcinoma

Marberger¹,

Simak

1993

Malignancies of the Genitourinary Tract

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Lymph Node Dissection in Radical Nephrectomy for Renal Cell Carcinoma: Is It Necessary?

Cited by 15 publications

References 7 publications

Prognostic Factors in Renal Carcinoma. An Evaluation of Operative Findings

Prognostic Factors in Renal Carcinoma. An Evaluation of Operative Findings

Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data

Organ-Sparing Excision of Renal Cell Carcinoma

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