Perioperative Morbidity of Lymph Node Dissection for Renal Cell Carcinoma: A Propensity Score-based Analysis

Eur Urol. 2018 Mar;73(3):469-475. doi: 10.1016/j.eururo.2017.10.020. Epub 2017 Nov 11.


Background: There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk-benefit ratio.

Objective: To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC.

Design, setting, and participants: A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND.

Intervention: RN with or without LND.

Outcome measurements and statistical analysis: Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis.

Results and limitations: A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design.

Conclusions: LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC.

Patient summary: Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications.

Keywords: Complications; Lymph node dissection; Nephrectomy; Propensity score; Renal cell carcinoma.