The role of lymphadenectomy in the management of renal cell carcinoma.

Skinner and deKernion's datum, like ours, suffers from the fact it is retrospective and not randomized. Therefore, it provides suggestive but not conclusive evidence that lymphadenectomy enhances the chances for survival of a patient with a given stage and grade of renal cell carcinoma. In our study, lymphadenectomy was defined as removal of the regional lymph nodes from the diaphragm to the bifurcation of the common iliac artery on the homolateral side, which was the usual type of lymphadenectomy performed in this retrospective analysis. Because information may be obtained from lymphadenectomy alone which allows a more accurate estimate of the patient's prognosis in 8 per cent of the cases, and because our data suggest a statistical improvement in survival in patients with stage C and D disease if lymphadenectomy is performed, it is recommended that patients undergoing radical nephrectomy for renal cell carcinoma have a regional lymphadenectomy performed at the same time. It is also recommended that a prospective randomized study of th role of lymphadenectomy in patients with a given stage and grade of renal cell carcinoma be undertaken.