The scope of lymphadenectomy in conservative surgery of patients with renal carcinoma

Abstract

Organ-saving operations (extended lymphadenectomy) were performed in 125 patients with renal carcinoma (RC) in the urological clinic of I. M. Sechenov Moscow Medical Academy between 1992 and 2002. In view of specific segment-by-segment lymph flow off the right and left kidneys, it is thought valid to remove paracaval and aortocaval lymph nodes in saving operations on the right kidney but in cancer of the left kidney it is recommended to remove paraaortic lymph nodes. Basing on the anatomical features, lymphodissection should be made from the eras of the diaphragm to bifurcation of the aorta. Metastases to the regional lymph nodes were diagnosed in 12 (9.6%) patients. In 8 of 12 patients with pN+ lymph node metastases were microscopic. Frequency of lymphogenic metastases directly correlated with the size and stage of the tumor, cancer cells differentiation degree. Metastatic involvement of the regional lymph nodes in renal cancer is an unfavourable prognostic factor as 5-year survival for the overall group of patients was 71.7% while for patients with pN+ it was 411%.