Table 1:
Overview of the studies
| Author, date, journal and country Study type (level of evidence) |
Patient group | Outcomes | Key results | Comments/weaknesses |
|---|---|---|---|---|
| Murthy et al. (2004), Ann Thorac Surg, USA [2] Prospective study (level 2C) |
92 patients undergoing pulmonary metastasectomy of RCC Histological data available for 32 patients (34.8%) |
Prevalence of LNI Survival Morbidity |
N+: 12 of 32 patients (37.5%) Location: 50% mediastinal (N2–N3) Median follow-up (years): 3.7 ± 3.1 OS: significantly lower in case of LNI In case of CR: 3 LNI: 30% 2 LNI: 45% 1 LNI: 55% 0 LNI: 65% (P = 0.004) None related to lymphadenectomy |
No impact of the number of lymph nodes dissected on survival Small number of patients for whom the histological data are available |
| Kanzaki et al. (2010), Eur J Cardiothorac Surg, Japan [3] Retrospective study (level 3C) |
48 patients (59 thoracotomies) for lung metastases of RCC Exclusion of patients when LNI is suspected on the preoperative CT scan |
Prevalence of LNI Recurrence |
N+: 5 of 48 patients (10.4%) 4 patients (8.3%) |
No information on the type of lymphadenectomy performed (sampling or radical?) |
| Plitz et al. (2002), Ann Thorac Surg, Germany [4] Retrospective study (level 3C) |
105 patients (150 thoracotomies) for lung metastases of RCC |
Survival Prognostic variable of survival Morbidity |
Five-year OS: pN0: 48% pN+: 0% LNI: independent prognostic factor (P = 0.0016, RR: 2.42, OR: 1.40–4.20) One recurrent laryngeal nerve paralysis (0.95%) |
No data on the prevalence of LNI |
| Pfannschmidt et al. (2002), Ann Thorac Surg, Germany [5] Retrospective review (level 3C) |
191 patients (248 thoracotomies) for lung metastases of RCC | Prevalence of LNI Prognostic variable of survival Survival Morbidity |
N+: 57 of 191 patients (29.9%) LNI: independent prognostic factor (P = 0.0038) Three-year OS: 31.4% (N+) vs 55.4% (N0) One oesophageal perforation (death on day 29) |
No difference found between mediastinal or hilar nodal involvement (P = 0.54) Retrospective study |
| Assouad et al. (2007), Ann Thorac Surg, France [6] Retrospective study (level 3C) |
65 patients undergoing lung metastasectomy for RCC Radical mediastinal lymphadenectomy performed in 67.7% of patients (44 of 65 patients) |
Prevalence of LNI Survival Prognostic variable of survival Morbidity |
N+: 13 of 44 patients (29.5%); N1: 6 (46.2%); N2: 7 (53.8%) 5-year OS: pN+: 0% pN−: 52% LNI: independent prognostic factor (P = 0.0018) None related to lymphadenectomy |
Retrospective study |
| Winter et al. (2010), J Urol, Germany [7] Retrospective review of a prospective database (level 3C) |
110 patients (156 thoracotomies) undergoing lung metastases for RCC | Prevalence of LNI Prognostic variable of survival Historical comparison Morbidity |
N+: 38 of 110 patients (34.5%); N1: 8 (7.3%), N2: 17 (15.5%), both N1 and N2: 13 (11.8%) Univariate analysis: Mean survival of pN0: 102.2 months, pN+: 19.1 months (pN2: 13.8 months, pN1: 28.9 months) (P < 0.001) Multivariate analysis: LNI is a prognostic factor: (RR: 5.8; CI: 2.5–13.3) Better OS in case of lymphadenectomy (HR: 0.66; CI: 0.41–1.06; P = 0.08) One recurrent laryngeal nerve paralysis (0.9%) and one chylous leak (0.9%) |
Retrospective study |
| Meimarakis et al. (2010), Am J Surg, Germany [8] Retrospective review of a prospective database (level 3C) |
202 patients with lung metastases of RCC 91 radical mediastinal lymphadenectomies (45%) |
Prevalence of LNI Survival rate Prognostic variable of survival Morbidity |
N+: 27 of 91 patients (30%) pN+: 19.1 (CI: 5.8–32.4) months vs pN0: 92.0 (CI: 35.7–148.2) months; (P < 0.001) LNI: independent prognostic factor (HR: 3.6; CI: 1.5–8.4; P < 0.004) None related to lymphadenectomy |
Retrospective study |
CI: confidence interval; CR: complete resection; HR: hazard ratio; LNI: nodal involvement; OR: odds ratio; OS: overall survival; RCC: renal cell carcinoma; RR: relative risk.