Presentation Authors: Marcelo Panizzutti Barboza*, Ryan Speir, Adam Calaway, Richard Foster, Hristos Kaimakliotis, Timothy Masterson, Ronald Boris, Clint Cary, Indianapolis, IN
Introduction: The role of retroperitoneal lymph node dissection (RPLND) in node only recurrences after nephrectomy for renal cell carcinoma (RCC) is ill-defined. We set out to examine the relapse pattern after RPLND in an attempt to define appropriate borders of dissection based on primary tumor location and nodal recurrence site.
Methods: We reviewed the records of 19 patients undergoing RPLND for RCC recurrences between 2011 and 2018. All patients included initially had primary non-metastatic RCC, and subsequent recurrence restricted to the retroperitoneal lymph nodes (LN). The initial LN recurrence site was defined relative to the side of nephrectomy (ipsilateral (ILN), contralateral (CLN), or bilateral (BLN)). The RPLND templates were either full bilateral, right modified, left modified, or a full left (Interaortocaval (IAC) +Para-aortic(PA) LNs). LN relapses after RPLND were assessed.
Results: The median age of our cohort was 60 years at RPLND. Median follow-up after RPLND was 29 months (IQR 22-38). The median time to recurrence after the initial nephrectomy was 10 months. Right (RNx) or left (LNx) nephrectomies were performed in 14 (73.7%) and 5 (26.3%), respectively. The extent of lymphadenectomy during nephrectomy varied based on surgical approach. After RNx there were 2 BLN, 1 CLN, and 11 ILN recurrences, while after LNx, 3 BLN, 1 CLN, and 1 ILN recurrences. These recurrences were treated according to surgeonâ€™s preference (Fig.). After RPLND, 8 patients relapsed in the retroperitoneum, 5(62.5%) infield only (2 PA, 1 PA+IAC, 2 IAC), 2(25%) out-of-field only (2 PA) and 1(12.5%) in/out-of-field (in-IAC/out-PA). Only 3 patients relapsed outside the RPLND template, 2 of 8 (25%) after a right template for RNx ILN recurrence, and one patient after a right template for LNx CLN recurrence. Eight (42%) patients remained disease free during the follow-up.
Conclusions: Overall the chance of infield relapse in IAC and PA LNs is high due possibly to the local aggressiveness of LN metastasis and/or a lack of standardized LN dissection at initial nephrectomy. Regardless, if RP recurrence occurs, a full bilateral standardized RPLND is indicated. Furthermore, RPLND can achieve complete remission in a significant proportion of RCC patients with node only recurrences.