Surgical Resection of Isolated Retroperitoneal Lymph Node Recurrence of Renal Cell Carcinoma Following Nephrectomy

Purpose: Durable survival has been reported following the resection of solitary metachronous metastasis of renal cell carcinoma at sites including the lung, bone and adrenal. We report our experience with resection of isolated retroperitoneal lymph node recurrence. Materials and Methods: Patients who underwent surgical resection of isolated metachronous recurrence of renal cell carcinoma in the retroperitoneal lymph nodes following radical nephrectomy for pT_anyN_anyM0 tumors were identified (group 1). Progression-free and cancer specific survival were estimated using the Kaplan-Meier method and compared to survival in patients who had pT_anyN+M0 disease at nephrectomy (group 2) and in patients who underwent complete resection of a solitary metachronous metastasis at other sites (group 3). Results: A total of 15 patients underwent resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma. Median time from nephrectomy to resection was 10.3 months (range 3 to 159). No patient received systemic therapy before resection. Recurrence was asymptomatic in all except 1 patient. No intraoperative or postoperative mortality occurred. Six patients subsequently died of renal cell carcinoma at a median of 18 months (range 6 to 33.6) following resection. Median progression-free survival in groups 1 to 3 was 9.1, 8.7 and 15.6 months, while median cancer specific survival was 33.3, 20.8 and 46.9 months, respectively. Conclusions: Resection of isolated retroperitoneal lymph node recurrence may be associated with survival rates approaching those of resection of solitary metastasis at other sites. The decreased time to progression relative to patients with resected metastasis at other sites likely reflects the aggressive biology of nodal disease.