Extension of survival by resection of asynchronous renal cell carcinoma metastases to mediastinal lymph nodes

Whitson, Bryan A.; Groth, Shawn S.; Andrade, Rafael S.; Garrett, Laurel; Dudek, Arkadiusz Z.; Jessurun, Jose; Maddaus, Michael A.

doi:10.1016/j.jtcvs.2007.12.016

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 5 , Pages 1022-1028, May 2008

Extension of survival by resection of asynchronous renal cell carcinoma metastases to mediastinal lymph nodes

Bryan A. Whitson, MD
- Department of Surgery, University of Minnesota, Minneapolis, Minn
Shawn S. Groth, MD
- Department of Surgery, University of Minnesota, Minneapolis, Minn
Rafael S. Andrade, MD
- Department of Surgery, University of Minnesota, Minneapolis, Minn
Laurel Garrett, BS
- Department of Surgery, University of Minnesota, Minneapolis, Minn
Arkadiusz Z. Dudek, MD, PhD
- Department of Medicine, University of Minnesota, Minneapolis, Minn
Jose Jessurun, MD
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minn
Michael A. Maddaus, MD
- Department of Surgery, University of Minnesota, Minneapolis, Minn
- Address for reprints: Michael A. Maddaus, MD, Professor and Program Director, University of Minnesota Department of Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455.

Received 2 July 2007; received in revised form 27 November 2007; accepted 18 December 2007.

Objective

The aim of this study was to determine whether or not resection of isolated mediastinal lymph node renal cell carcinoma metastases confers a survival advantage, as compared with patients with stage IV disease.

Patients and Methods

We retrospectively reviewed the charts of all patients with renal cell carcinoma whose histologic specimens were evaluated at our institution from January 1, 2000, through December 31, 2006. Using Kaplan–Meier estimates, we compared the survival of patients who underwent resection of asynchronous mediastinal lymph node metastases with that of patients with stage IV disease.

Results

During the 7-year study period, of the 386 patients with renal cell carcinoma who were evaluated at our institution, 9 underwent resection of asynchronous mediastinal lymph node metastases. After primary tumor resection and before diagnosis of asynchronous mediastinal lymph node metastases, all patients completed chemotherapy, cytokine therapy, or tumor vaccination; 3 underwent radiotherapy. The median age at resection of mediastinal lymph nodes was 57.7 years (range, 39.7–81.2). The median time from primary tumor resection to mediastinal lymph node resection was 2.8 years (range, 0.5–23.3). In all, 4 patients underwent resection of metastases via thoracotomy and 5, via thoracoscopy. The median number of mediastinal lymph nodes pathologically evaluated was 7 (range, 2–28); the median number of positive mediastinal lymph nodes per patient was 1.5 (range, 1–3). We found no surgical complications. The median survival after resection of metastases (3.2 years) was significantly longer (P = .021) than for other patients with stage IV disease at our institution (1.1 years).

Conclusions

Resection of renal cell carcinoma mediastinal lymph node metastases is safe, appears to extend survival, and should be considered an important component of treating patients with renal cell carcinoma who have asynchronous mediastinal lymph node metastases.

Abbreviations and Acronyms: IL-2, interleukin 2, MLN, mediastinal lymph node, RCC, renal cell carcinoma

CTSNet Classification: 13