Retroperitoneal lymph node dissection for isolated node recurrence of renal cell carcinoma after nephrectomy: a systematic review.
Alberto Costa Silva, Noel Clarke, Aziz Gulamhusein
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In 30 seconds
This systematic review assessed perioperative and oncologic outcomes after retroperitoneal lymph node dissection (RPLND) for isolated nodal recurrence of renal cell carcinoma following nephrectomy. It included seven retrospective studies published from 2008 to 2022, encompassing 144 patients. Complications occurred in 26-47%, with major complications in approximately 10%. Median recurrence-free or progression-free survival ranged from 9 to 19.5 months, while 5-year cancer-specific survival ranged from 61% to 74%. The authors conclude that RPLND is an option, but prospective studies are needed to clarify patient selection and its role alongside contemporary systemic therapy.
Key findings
- Across seven retrospective studies involving 144 patients, overall complication rates were 26-47%; major complications occurred in approximately 10%.
- Median recurrence-free or progression-free survival ranged from 9 to 19.5 months.
- Five-year cancer-specific survival ranged from 61% to 74%.
- Adverse prognostic factors included disease-free interval ≤ 12 months, high-grade tumors, pN1 status, and nodal metastasis > 3 cm.
Why it matters
The review summarises outcomes for a specific recurrence pattern in which optimal management remains undefined. It indicates that RPLND can be considered as an option, while also showing meaningful perioperative morbidity and variable disease control. These findings help frame discussions of potential benefits and risks, but the retrospective evidence does not establish comparative effectiveness or identify definitive selection criteria.
What to keep in mind
Evidence came from seven retrospective studies, and the authors call for prospective multicentre studies to clarify patient selection and treatment integration.