Videolaparoscopic management of lymph nodal recurrence of renal cell carcinoma
Introduction
Post-surgical recurrence of renal carcinoma (RC) represent a significant therapeutic
challenge as this tumor has a well-documented resistance to conventional chemotherapy and
radiatherapy. Therefore complete surgical resection remains the only potentially curative
option. Isolated retroperitoneal nodal recurrence of RC represents a subset of local disease
which may demonstrate a unique disease course and response to surgical intervention. In
this video we report laparoscopic approach for retroperitoneal lymph node dissection.
Materials and Methods
A 53 years old patient who underwent in February 2012 open radical right nephrectomy for mixed
renal tumor (clear cell carcinoma and papillary pattern carcinoma, pT3bpN1M0) followed by first
line adjuvant chemotherapy (Pazopanib 200 mg; 1 cpr/8h for 12 months). The CT scan 6 months
after chemotherapy showed 2 cm lateroaortic and inteaortocaval lymphadenopathies. Therefore the
patient underwent a retroperitoneal laparoscopic lympho-node dissection.
Results
Operative time was 180 minutes. Blood loss was 50 ml. There were no peri or postoperative
complications. The patient was dismissed in four days. The histological examination
demonstrated lymph node metastasis of renal papillary growth pattern. At 6 months
follow-up the CT scan did not show recurrences. The patient is actually in good clinical
conditions.
Discussion
Surgical resection of isolated retroperitoneal nodal recurrence of RC must be considered as
a distinct subset of locoregional disease. To date it has not still been well described.
Minimally invasive resection of retroperitoneal lymph nodes can be offered as a part of a
multimodal treatment approach to patients with an isolated recurrence of RC who have an
acceptable comorbidity index. Obviously these patients should also be considered for
enrollment in adjuvant therapy trials.
Conclusions
While minimally invasive surgical resection of retroperitoneal lymph node metastases is
technically challenging, it is feasible and may be an effective curative option for isolated
nodal recurrence of RC.