Herrlinger A, Schrott K M, Schott G, Sigel A
Clinic of Urology, University of Erlangen-Nuernberg, Germany.
J Urol. 1991 Nov;146(5):1224-7. doi: 10.1016/s0022-5347(17)38052-7.
In a prospective study of 511 patients we compared the data of 320 who underwent systematically extended dissection of the regional lymph nodes with data of 191 who underwent only facultative dissection of the lymph nodes, which means that no lymph nodes had been removed or only a few were taken for staging purposes. Only patients without distant metastases and who were less than 72 years old were included. All patients were treated with a transabdominal approach. The incidence of positive nodes in the patients with systematically extended lymphadenectomy was 17.5% and for patients with facultative lymphadenectomy it was 10%. Survival rates of patients with facultative lymphadenectomy were 58% after 5 years and 40.9% after 10 years, compared to 66% and 56.1%, respectively, for patients with systematically extended lymphadenectomy (p less than 0.01). Patients with stage pT1-2 (Robson stage I) and pT3aN0M0 (Robson stage II) tumor obviously had the highest benefits with extended lymphadenectomy. Operative mortality was less than 1% after systematically extended lymphadenectomy and 3.8% after facultative lymphadenectomy. We conclude from our data that the systematic and extended lymphadenectomy improves the prognosis of patients with renal cell carcinoma without any additional operative risks.
在一项针对511例患者的前瞻性研究中，我们将320例行区域淋巴结系统性扩大清扫术患者的数据与191例仅行选择性淋巴结清扫术患者的数据进行了比较，后者意味着未切除任何淋巴结或仅切除少数淋巴结用于分期。仅纳入无远处转移且年龄小于72岁的患者。所有患者均采用经腹入路治疗。系统性扩大淋巴结清扫术患者的阳性淋巴结发生率为17.5%，选择性淋巴结清扫术患者为10%。选择性淋巴结清扫术患者5年后的生存率为58%，10年后为40.9%，而系统性扩大淋巴结清扫术患者分别为66%和56.1%（p<0.01）。pT1-2期（罗布森I期）和pT3aN0M0期（罗布森II期）肿瘤患者显然从扩大淋巴结清扫术中获益最大。系统性扩大淋巴结清扫术后手术死亡率低于1%，选择性淋巴结清扫术后为3.8%。我们从数据中得出结论，系统性扩大淋巴结清扫术可改善肾细胞癌患者的预后，且无任何额外手术风险。
