| Abstrakt: |
Background: several retrospective studies have sugested a proportion of patients with positive lymph node benefits from lymph node dissection (LND) at the time of radical nephrectomy (RN) for renal cell carcinoma (RCC). Objective: Our aim was to report de clinical and histological features of patients with isolated positive lymph nodes who underwent LND at the time of nephrectomies and the impact of LND on survival rate. Objective: Our aim was to report de clinical and histological features of patients with isolated positive lymph nodes who underwent LND at the time of nephrectomies and the impact of LND on survival rate. Materials and methods: A retrospective study was carried out on all patients with histopathologicaly confirmed renal cell carcinoma with isolated positive lymph nodes metastases between january 2005 and december 2007. Positive lymph nodes were confirmed in 39 patients (10,3% of all nepherectomies asociated with LND).We excluded 18 pacients with sistemic metastases (pulmonary,bone etc) .We evaluated a group of 21 patients withpositive lymph nodes (with no evidence of systemic metastases) who underwent extended lymph node dissection ( from ipsilateral great vessels ,from the crus of the diaphragm to bifurcation of ipsilateral great vessel +/- interaorticocaval region) at the time of RN.All patients were preoperatively evaluated with history, clinical examination, blood samples, abdominal ultrasound , helical abdominal CT scan , chest X-Ray ( thoracic CT). All the specimens were assesed by the same pathologist.Follow-up consisted of history, physical examination ,helical abdominal CT scan, chest X-Ray ( thoracic CT ). We calculated overall survival rate at 3 years. Results: Preoperative CT scan revealed false-negative results in4 cases (19%)(size of lymph node less than 1 cm ).Out of 21 patients, 11 (52,3 %) had clear cell hystology, 5 (23%) papillary, 4 (19%) cromophobe RCC, 5 had sarcomatoid features (23%).Massive tumour necrosis was discovered in 17 cases(80%). Over 80% of pacients have staged T3 and T4 (TNM system) (median tumour size was 9,5 cm); 19 patients(90%) have Fuhrman nuclear grade III and IV. Lymph node size ranges between 0,3 cm and 4,5 cm.We have 8 cancer-free patients at 3 years (38 % and 2,1 % of all LND associated with RN performed in that period). No patient having sarcomatoid component or nuclear grade 4 survived. These pacients have less than 4 lymph node metastases (3 patients with single positive lymph node - size 2 cm, 2,5 cm and respectively 2,8 cm; 2patients had 2 positive lymph nodes - maximum size 0,3 cm, 3 patiens with 3 nodal metastases - maximum size 0,6 cm ). Median survival was 23 months.This study is limited by its retrospective feature. Conclusions: Renal cell carcinoma with isolated positive lymph nodes are agresive cancers with high Fuhrmann nuclear grade, large tumor size. Prognostic is poor.Some benefit may have those with less than 4 isolated positive lymph nodes. [ABSTRACT FROM AUTHOR] |
