Occurrence and Localization of Lymph Node Metastases in Renal Carcinoma: A Lymphographic and Histopathological Investigation in Connection with Nephrectomy

Abstract

The occurrence of lymph node metastases and their localization has been studied in 22 patients operated for renal carcinoma by perifascial nephrectomy and retroperitoneal lymph node dissection. The result is based on histological examination of 1038 dissected lymph nodes from different regions. Lymph node metastases in lumbar lymph nodes and in homo-lateral iliac lymph nodes were found in 27%. In one case a supraclavicular lymph node metastasis was revealed without any other findings of spread to the lymphatics. The mechanism of spreading to the lymph nodes is discussed and the supraclavicular nodes are proposed as a possible site for early metastasizing.Lymphography as an adjunct in the preoperative establishment of lymph node metastases has been evaluated. The lymphographic findings correlated poorly with histologically proved metastases. However, the value of lymphography as an important way of checking the lymph node dissection is stressed.The investigation indicates that if removal of lymph node metastases is to be carried out in patients with renal carcinoma, the dissection must include not only the lumbar lymph nodes bilaterally, but also the nodes along the common iliac vessels at least on the homo-lateral side. Lymph nodes in the supraclavicular region should also be dissected for a better prognostic evaluation.