Does extended lymph node sampling during renal tumour surgery increase complications?

Patients undergoing more extensive lymph node sampling during surgery for a suspected malignant paediatric renal tumour do not appear to have a higher likelihood of experiencing clinically significant complications, reveals a study.

The authors carried out a single-institution, retrospective review of paediatric patients (aged 0‒18 years) undergoing extirpative renal surgery with lymph node sampling for a suspected malignancy between 2005 and 2019. Those with 0 or an unknown number of lymph nodes sampled or <150 days of follow-up were not included in the study.

A clinically significant complication was characterized by a Clavien complication ≥III, small-bowel obstruction, chylous ascites, organ injury, or wound infection. The authors then examined the number of lymph nodes sampled and its influence on the odds of having a clinically significant complication.

Overall, 144 patients (median age 38 months) were eligible for inclusion. Of these, 21 (15 percent) had a clinically significant complication. The most common complication was ileus/small bowel obstruction (n=16). Multivariate analysis revealed that increased lymph node yield did not influence the likelihood of experiencing a clinically significant complication (p=0.6).

Further studies on protocol adherence, staging accuracy, and survival trends using a lymph node sampling template are warranted.

“Although Children’s Oncology Group renal tumour protocols mandate lymph node sampling during extirpative surgery for paediatric renal tumours, lymph node sampling is often omitted or low yield,” the authors said. “Concerns over morbidity associated with extended lymph node sampling have led to hesitancy in adopting a formal lymph node sampling template.”