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Eur Urol. 2017 Nov 10. pii: S0302-2838(17)30911-9. doi: 10.1016/j.eururo.2017.10.020. [Epub ahead of print]

Perioperative Morbidity of Lymph Node Dissection for Renal Cell Carcinoma: A Propensity Score-based Analysis.

Author information

1
Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA. Electronic address: Boris.Gershman@lifespan.org.
2
Department of Urology, University of Illinois, Chicago, IL, USA.
3
Department of Urology, Mayo Clinic, Rochester, MN, USA.
4
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
5
Department of Oncology, Mayo Clinic, Rochester, MN, USA.
6
Department of Pathology, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk-benefit ratio.

OBJECTIVE:

To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC.

DESIGN, SETTING, AND PARTICIPANTS:

A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND.

INTERVENTION:

RN with or without LND.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis.

RESULTS AND LIMITATIONS:

A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design.

CONCLUSIONS:

LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC.

PATIENT SUMMARY:

Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications.

KEYWORDS:

Complications; Lymph node dissection; Nephrectomy; Propensity score; Renal cell carcinoma

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