Aggressive Surgical Approach to Renal Cell Carcinoma: Review of 130 Cases

Abstract

A retrospective analysis of 130 patients with renal cell carcinoma seen between 1957 and 1977 disclosed important diagnostic and pathologic factors relating to prognosis. Initial symptoms did not correlate with prognosis but 1/3 of the patients had metastases when first seen by a physician. The classic triad of hematuria, flank pain and mass was present in only 4% of the patients. Angiography demonstrated hypervascular tumors in 93% of the patients. Hypovascularity on an angiogram correlated well with papillary renal cell carcinoma with improved prognosis. The renal vein was involved in 21% of the patients and the inferior vena cava was involved in 4%. Radical nephrectomy with or without lymph nodes dissection was the most common operation and heminephrectomy was performed in patients with a solitary kidney or hypoplastic contralateral kidney. Management of tumor thrombus in the renal vein of inferior vena cava required specialized operative techniques, including vena caval resection in 5 patients. Survival rates were calculated for each pathologic stage, with subgroups of renal vein or inferior vena caval involvement. Patients with stage I or II disease, with or without renal vein or vena caval involvement, had a much better prognosis than patients with stage III or IV disease. The addition of lymphadenectomy revealed many patients with unsuspected metastatic disease. Survival was increased when only a small number of lymph nodes were involved, suggesting some therapeutic as well as diagnostic gain from associated lymphadenectomy. Absolute lymphocyte counts of more than 2000, as a reflection of immunologic status of the patient, did not correlate with survival rates.