Summaries: International Kidney Cancer Symposium
Conclusion: there is no increased risk of doing the lymph node dissection early on. Dr. Eggener-CON
Basics
Lymph node dissections rarely done, even for large tumors, because there is no proven therapeutic or staging benefit for low risk patients. A Mayo study revealed no data showing therapeutic benefit in high risk patients. For clinically node negative high risk patients, there is staging value but no proven therapeutic benefit.
Rate of positive nodes is associated with stage and grade; the higher the stage and grade, the more likely there will be positive nodes. A tumor> 10 cm with sarcomatoid features and tumor necrosis is also associated with positive nodes.
Looking at several studies, the percentage of patients that were found to have positive nodes at the time of surgery was relatively small in all but one study. The 5-year cancer specific survival for these patients was very consistent at 35-39%.
According to the National Comprehensive Cancer Network guidelines for kidney cancer,“Regional lymph node dissection is optional but is recommended for patients with adenopathy on preoperative imaging or palpable/visible adenopathy at time of surgery.”
Conclusions:
Lymph node dissection for patients with clinical node negative T1-T2 disease is proven not to be necessary
Lymph node dissection for patients with clinical node negative T3-T4 disease is reasonable but of unproven therapeutic benefit
L...
Source: Kidney Cancer Association - Category: Urology & Nephrology Source Type: news
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