Laparoscopic Lymph Node Dissection in Clinically Node-Negative Patients Undergoing Laparoscopic Nephrectomy for Renal Carcinoma

ObjectivesAccurate staging of renal cell carcinoma (RCC) is important when risk-stratifying patients for clinical trials and identifying patients most likely to benefit from adjuvant therapy. We investigated the feasibility and potential role of laparoscopic lymph node dissection (LND) in patients undergoing radical nephrectomy with clinically node-negative RCC.MethodsWe retrospectively compared 50 consecutive patients undergoing laparoscopic nephrectomy without LND (Nx group) with 50 consecutive patients undergoing combined laparoscopic nephrectomy and retroperitoneal LND (LND group).ResultsThe two groups had similar clinical and pathological characteristics; the only difference was a higher proportion of non–clear cell histology in the LND group. In the Nx group, no patient was identified as having node-positive RCC; 5 of 50 patients (10%) in the LND group had nodal disease (P = 0.0155). Among a subgroup of patients with clinically localized RCC, 3 of 46 (6.5%) patients had node-positive disease identified by LND. All patients with positive nodes had primary tumors that were at least 7 cm in diameter, pT3 or pT4, and high grade. With increased surgeon experience, extent of the LND was incrementally increased. The mean number of nodes recovered was 7.8; however, a mean of 12.1 nodes were recovered using an extended LND. The mean numbers of nodes recovered from the paraaortic, interaortocaval, paracaval, and retrocaval regions were 9.8, 4.2, 2.4, and 5.0, respectively. The overall risk of intraoperative and postoperative complications was similar between groups.ConclusionsLaparoscopic LND in patients undergoing nephrectomy for RCC is safe and feasible, and may improve staging accuracy.