Lymphnode Dissection during RN: is it necessary?
During the Mock Examination conducted recently, a case of >5 Cm RCC was discussed which also had IVC Thrombus.
During the discussion, no doubt Radical Nephrectomy was suggested by both candidates and agreed by the Examiner along with IVC Thrombectomy. The issue debated was on ‘Role of Lymphadenectomy along with RN’. One of the candidate opined that he would perform Lymphnode dissection extending from the Crux of the Diaphragm to Aortic Bifurcation. This was not accepted by the Examiner and probably rightly so. Though from the time of Eric Riches and earlier Rubin Flocks, many have suggested additional Lymphnode Dissection but recent studies by many present and immediate past contributors for RCC, mentioned that additional Lymphnode dissection is not going to modify the prognosis.
I am providing an article based on Canadian Multi-instructional Analysis on Lymphnode Dissection during RN (published Online in Urologic Oncology, March 27th. They concluded by stating that ‘LND at the time of radical nephrectomy for renal cell carcinoma is not associated with improved outcomes. There was no benefit in patients at high risk for nodal metastases, and the number of nodes removed did not correlate with survival’.
As mentioned, many have aired similar view.