Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

• Published in: The Annals of thoracic surgery Vol. 109; no. 1; pp. 262 - 269
• Main Authors: Sponholz, Stefan, Schirren, Moritz, Oguzhan, Selma, Mese, Mesut, Schirren, Joachim
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2020
• Subjects: Adult; Aged; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Disease-Free Survival; Female; Humans; Kidney Neoplasms - secondary; Kidney Neoplasms - surgery; Lymph Node Excision - methods; Lymphatic Metastasis; Male; Metastasectomy; Middle Aged; Retrospective Studies; Thorax; Time Factors; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2019.07.054

Isolated thoracic lymph node metastases (ITLNMs) without any lung metastases of renal cell cancer are rare. Other than a few case reports and one study, there is no further literature on ITLNMs. For this reason, the goal of this study was to analyze our experiences, the long-term survival outcomes, and recurrence-free survival outcomes after the resection of ITLNMs. We analyzed our database of 15 patients with ITLNMs who underwent metastasectomy by systematic lymph node dissection from 2003 to 2017. The long-term outcomes and survival curves were analyzed with the Kaplan-Meier method. The median disease-free interval between primary cancer and ITLNM was 40 months (range, 0-171 months). The R0 resection rate was 93.3% (n = 14). There was one R2 resection, which was due to a tracheal and left main bronchial infiltration. The postoperative morbidity and 30-day mortality rates were 13.3% and 0%, respectively. Altogether, 14 patients were included in the long-term follow-up with a median follow-up time of 35.5 months (range, 2-108 months). The 1-, 3-, and 5-year survival rates were 93%, 73%, and 73%, respectively. The median overall progression-free survival after metastasectomy was 18 months (95% confidence interval, 8.6-27.4 months), and the 5-year local recurrence-free rate was 65%. Because of the long disease-free interval between primary cancer and ITLNM, a long oncologic follow-up that includes chest images should be mandatory. Altogether, metastasectomy of ITLNMs is feasible with low morbidity and mortality rates and might be associated with promising survival rates. Early detection and resection of ITLNMs may avoid severe complications.