OBJECTIVES: We assessed the influence of tumor size and surgical approach on the use of lymphadenectomy and adrenalectomy with radical nephrectomy. METHODS: We evaluated patients with renal cell carcinoma (RCC) enrolled in the U.S. Kidney Cancer Study, a case-control study in the metropolitan areas of Detroit and Chicago from 2002 to 2007. We identified patients who underwent open (ORN) or laparoscopic radical nephrectomy (LRN). We used medical records and Surveillance, Epidemiology, and End Results (SEER) data to determine the proportion of patients who underwent lymphadenectomy or adrenalectomy. Bivariate analyses were performed to evaluate associations between tumor size, surgical approach, and receipt of lymphadenectomy or adrenalectomy. RESULTS: We identified 730 patients who underwent ORN (427, 58%) or LRN (303, 42%) for RCC from 2002 to 2007. Among this group, 11% and 24% underwent lymphadenectomy or adrenalectomy, respectively. Lymphadenectomy was more common among patients treated from an open surgical approach (14.1% ORN vs. 5.9% LRN, P < 0.01); this difference was most pronounced for cases with tumors between 4 and 7 cm (15.9% vs. 2.9%, P = 0.01). Patients treated with ORN were also more likely to undergo adrenalectomy, with the greatest discrepancy among cases with tumors ≤ 4 cm (21.7% vs. 11.4%, P < 0.01). CONCLUSIONS: Among patients undergoing radical nephrectomy for RCC, the use of lymphadenectomy and adrenalectomy is relatively uncommon and varies by tumor size and surgical approach. With an increasing number of patients with small tumors, the diffusion of laparoscopy, and the emergence of clinical trials evaluating systemic adjuvant therapies, our findings highlight important considerations for optimizing surgical management of patients with RCC.
OBJECTIVES: We assessed the influence of tumor size and surgical approach on the use of lymphadenectomy and adrenalectomy with radical nephrectomy. METHODS: We evaluated patients with renal cell carcinoma (RCC) enrolled in the U.S. Kidney Cancer Study, a case-control study in the metropolitan areas of Detroit and Chicago from 2002 to 2007. We identified patients who underwent open (ORN) or laparoscopic radical nephrectomy (LRN). We used medical records and Surveillance, Epidemiology, and End Results (SEER) data to determine the proportion of patients who underwent lymphadenectomy or adrenalectomy. Bivariate analyses were performed to evaluate associations between tumor size, surgical approach, and receipt of lymphadenectomy or adrenalectomy. RESULTS: We identified 730 patients who underwent ORN (427, 58%) or LRN (303, 42%) for RCC from 2002 to 2007. Among this group, 11% and 24% underwent lymphadenectomy or adrenalectomy, respectively. Lymphadenectomy was more common among patients treated from an open surgical approach (14.1% ORN vs. 5.9% LRN, P < 0.01); this difference was most pronounced for cases with tumors between 4 and 7 cm (15.9% vs. 2.9%, P = 0.01). Patients treated with ORN were also more likely to undergo adrenalectomy, with the greatest discrepancy among cases with tumors ≤ 4 cm (21.7% vs. 11.4%, P < 0.01). CONCLUSIONS: Among patients undergoing radical nephrectomy for RCC, the use of lymphadenectomy and adrenalectomy is relatively uncommon and varies by tumor size and surgical approach. With an increasing number of patients with small tumors, the diffusion of laparoscopy, and the emergence of clinical trials evaluating systemic adjuvant therapies, our findings highlight important considerations for optimizing surgical management of patients with RCC.
Authors: Steven C Campbell; Andrew C Novick; Arie Belldegrun; Michael L Blute; George K Chow; Ithaar H Derweesh; Martha M Faraday; Jihad H Kaouk; Raymond J Leveillee; Surena F Matin; Paul Russo; Robert G Uzzo Journal: J Urol Date: 2009-08-14 Impact factor: 7.450
Authors: John M Hollingsworth; David C Miller; Stephanie Daignault; Brent K Hollenbeck Journal: J Natl Cancer Inst Date: 2006-09-20 Impact factor: 13.506
Authors: Ken-Ryu Han; Matthew H T Bui; Allan J Pantuck; Danielo G Freitas; Bradley C Leibovich; Fredercik J Dorey; Amnon Zisman; Nicolette K Janzen; Hideki Mukouyama; Robert A Figlin; Aie S Belldegrun Journal: J Urol Date: 2003-03 Impact factor: 7.450
Authors: Christopher J Kane; Katherine Mallin; Jamie Ritchey; Matthew R Cooperberg; Peter R Carroll Journal: Cancer Date: 2008-07-01 Impact factor: 6.860
Authors: Jan H M Blom; Hein van Poppel; Jean M Maréchal; Didier Jacqmin; Fritz H Schröder; Linda de Prijck; Richard Sylvester Journal: Eur Urol Date: 2008-10-01 Impact factor: 20.096
Authors: Wassim M Bazzi; Daniel D Sjoberg; Michael A Feuerstein; Alexandra Maschino; Sweeney Verma; Melanie Bernstein; Matthew F O'Brien; Thomas Jang; William Lowrance; Robert J Motzer; Paul Russo Journal: J Urol Date: 2014-12-15 Impact factor: 7.450