Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma

Abstract

ObjectiveTo evaluate the outcome of patients after surgical resection of isolated retroperitoneal lymph node (RPLN) recurrence of renal cell carcinoma (RCC) using a multicentre international cohort. Patients and MethodsIn all, 50 patients were identified who underwent resection of isolated RPLN recurrence of RCC at four institutions after nephrectomy for pT any N any M0 disease. Progression-free (PFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association of clinicopathological characteristics with disease progression. ResultsThe median (interquartile range, IQR) age at resection was 57.0 (50.0-62.5) years. The median (IQR) time to RPLN recurrence after nephrectomy was 12.6 (6.9-39.5) months, with no significant difference in median time to RPLN recurrence between patients with N+ disease at nephrectomy (10.7 [6.5-24.6] months) and those with Nx/pN0 disease at nephrectomy (13.7 [8.7-44.2] months) (P = 0.66). The median (IQR) size of the RPLN recurrence before resection was 2.6 (1.9-5) cm. The most common site for RPLN recurrence was within the interaortocaval region (34%). The median (IQR) follow-up after RPLN resection for patients alive at last follow-up was 28.0 (13.7-51.2) months. During follow-up, 26 patients developed RCC recurrence, at a median (IQR) of 9.9 (4.0-18.5) months after RPLN resection. Of those who developed a secondary recurrence, disease was again isolated to the retroperitoneum in seven patients. In all, 11 patients subsequently died, including 10 who died from disease. The median PFS after RPLN resection was 19.5 months, with a 3-and 5-year PFS of 40.5% and 35.4%, respectively. We also found that RPLN recurrence at ≤12 months after nephrectomy was associated with a significantly inferior median PFS (12.3 months) compared with RPLN recurrence at >12 months after nephrectomy (47.6 months; P = 0.003). Moreover, on multivariate analysis, a shorter time to recurrence remained associated with a significantly increased risk for subsequent disease progression (hazard ratio 3.51; P = 0.005). ConclusionSurgical resection of isolated RPLN recurrence from RCC may result in durable cancer control in appropriately selected patients. Recurrence at ≤12 months after nephrectomy was associated with a significantly increased risk of progression after resection, underscoring the importance of this variable for risk stratification. Thus, we recommend that, in the setting of isolated RPLN recurrence of RCC (in patients without precluding comorbidities), careful consideration with the patients and medical oncology colleagues be undertaken about the relative and individualised benefits of surgical resection, systemic therapy, and surveillance.

The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta‐analysis

“…). The number of studies included for each specific aim are as follows: PA1/PA2: nine reports representing eight unique studies []; SA1: six studies (of which two represented separate analyses of the same dataset) ; SA2: 15 studies (of which one single‐institutional study was included in a multi‐institutional study) ; SA3: five studies ; SA4: 10 studies ; and SA5: 18 studies .…”

“… ACM, all‐cause mortality; CSM, cancer‐specific mortality; CSS, cancer‐specific survival; ECOG PS, Eastern Cooperative Oncology Group Performance Status; HR, hazard ratio; LN, lymph node; LND, lymph node dissection; MFS, metastasis‐free survival; MVA, multivariable analysis; NR, not reported; OS, overall survival; PFS, progression‐free survival. *Single‐institutional study also included in multi‐institutional study by Russel (2016) . † Survival estimate for pN+ V0.…”

“…Three studies reported on outcomes following salvage LND for isolated retroperitoneal nodal recurrence (Table ) . Five‐year CSS ranged from 35% to 74%.…”

“…Five‐year CSS ranged from 35% to 74%. In one single‐institutional report that was included in a subsequent multi‐institutional collaboration , the authors noted that survival after resection of isolated retroperitoneal recurrence was similar to that following isolated LN metastases at the time of nephrectomy.…”

Robot-Assisted Retroperitoneal Lymphadenectomy In A Patient With Type I Papillary Renal Cancer Recurrence After Five Years Of Follow-Up: A Case Report.

“…Russell et al identi ed 50 patients who underwent resection of isolated retroperitoneal lymphadenectomy (RPLN) recurrence of RCC after nephrectomy. They found that those patients with a longer interval from nephrectomy to RPLN recurrence had signi cantly decreased risks of progression after resection, suggesting that this variable may be used in patient selection [16].…”