ORLANDO, FL USA (UroToday.com) - The benefits and value of lymph node dissection (LND) in patients with advanced renal cell carcinoma (RCC) still remains in debate. Volpe and colleagues performed this multi-center European study to assess the changes in LND rate and nodal yield during radical nephrectomy (RN) during the last 3 decades.
The authors retrospectively reviewed a prospectively maintained database including 2 884 patients treated with RN at three European academic institutions between 1983 and 2012. They assessed the change of LND rate over time by dividing patients into 6 groups according to the year of surgery (1983-7 vs 1988-92 vs 1993-7 vs 1998-2002 vs 2003-7 vs 2008-12). Additionally, they evaluated the temporal trend of the overall LND rate and that of the rate of LNDs performed with different nodal yields (≥ 4 nodes and ≥ 12 nodes). The association between the number of lymph nodes (LNs) removed and the year of surgery was also assessed.
Among 2 884 patients treated with RN in the study period, 53.7% underwent a LND with removal of a median of 7 LNs. There was a significant progressive reduction of the overall LND rate over time (80% in 1983-87 vs 36% in 2008-12; p < 0.001). The same trend was observed for the number of LNDs performed with ≥ 4 nodes removed (69.4% in 1983-7 vs 25.4% 31.3 in 2008-12; p < 0.001) and for those performed with ≥12 nodes removed (31.3% in 1983-7 vs 9.3% in 2008-12; p < 0.001). In all cases, a stable LND rate was observed in the last 10 years. A significant association between number of LNs removed and year of surgery was detected (p < 0.001).
In conclusion, the number of LNDs performed during RN has been significantly decreasing in the last 30 years, with a stable rate in the last decade. The number of LNDs performed with an adequate LN yield for staging has also been significantly decreasing, representing a potential quality of care concern.
Presented by Alexander Volpe at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Novara, Italy
Written by Zhamshid Okhunov, MD, University of California (Irvine), and medical writer for UroToday.com
