Radical Nephrectomy With And Without Regional Lymph Node Dissection In Localized Renal Cell Carcinoma:Clinical Significance Of Survival Rates And Pathological Staging

Objective:To assess whether a regional lymph node dissection in conjunction with a radical nephrectomy for localized renal cell carcinoma on survival rates and pathological staging is more effective than a radical nephrectomy alone. Methods:We reviewed the operative and pathological reports of89patients with localized RCC submitted for RN at urological department of The Xinjiang Autonomous Regional Hospital from January2006to December2012. On the basis of the regional lymph node whether intraoperatively dissected divided into radical nephrectomy group (group S, n=46), radical nephrectomy+regional lymph node dissection group (S+LND group, n=43). Count the number of cases of each group according to gender, age, nationality, tumor side, tumor size, pathological type, pathological staging, preoperative cTNM staging, preoperative clinical staging, operation method, the number of lymph node dissection, the number of positive lymph node, postoperative pTNM staging, postoperative clinical staging, surgical complications. To assess the value of regional lymph node dissection for localized renal cell carcinoma. Meanwhile, the surgical complications and the one-year, two-year, three-year survival rates were analyzed. Results:There has been no statistical difference between the two groups on gender, age, nationality, tumor side, tumor size, pathological type, pathological staging, preoperative cTNM staging, preoperative clinical staging, postoperative pTNM staging, postoperative clinical staging(P>0.05). There has been statistical difference between the two groups on operation method and the number of lymph node dissection(P<0.05). In198patients, according to the number of lymph node dissection, the patients were divided into two groups:group1(<13), group2(>13). The lymph node metastasis rates of group1is10.1%, group2is22.0%. Group2had a higher lymph node metastasis rates than group1. The surgical complications rates of group S is4.3%, group S+LND is7.0%. There has been no statistical difference on surgical complications between the two groups (F>0.05). There have been72/89cases acquired follow-up, the follow-up rates is80.9%. Postoperative follow-up time is1-7years, the mean follow-up time is (4.5±1.6) years. The one-year survival rates of group S is97.4%, group S+LND is97.1%. The two-year survival rates of group S is96.9%, group S+LND is93.3%.The three-year survival rates of group S is92.3%, group S+LND is88.0%. There has been no statistical difference on one-year, two-year, three-year survival rates between the two groups (P>0.05). Conclusion:In the surgical treatment of localized renal cell carcinoma, radical nephrectomy with regional lymph node dissection doesn’t increase the incidence of surgical complications, it plays an important role in postoperative tumor pathological staging, with the increase of the number of lymph node dissection, lymph node metastasis rates also increased. There are no significant improvements on one-year, two-year and three-year survival rates between the two groups.