BACKGROUND There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk-benefit ratio. OBJECTIVE To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC. DESIGN, SETTING, AND PARTICIPANTS A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND. INTERVENTION RN with or without LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis. RESULTS AND LIMITATIONS A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design. CONCLUSIONS LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC. PATIENT SUMMARY Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications.

中文翻译：

---

肾细胞癌淋巴结清扫的围手术期发病率：基于倾向评分的分析。

背景 关于肾细胞癌 (RCC) 淋巴结清扫术 (LND) 的发病率以评估其风险收益比的数据很少。目的评估 LND 与 RCC 根治性肾切除术 (RN) 患者 30 天并发症的关系。设计、设置和参与者 1990 年至 2010 年间，共有 2066 名患者接受了 M0 或 M1 RCC 的 RN，其中 774 名 (37%) 接受了 LND。干预 RN 有或没有 LND。结果测量和统计分析 LND 与 30 天并发症的关联使用逻辑回归和几种倾向评分技术进行了检查。在敏感性分析中检查了扩展的 LND，定义为切除≥13 个淋巴结。结果和局限性 共有 184 名 (9%) 患者为 pN1，302 名 (15%) 患者为 M1。194 名 (9%) 患者出现 30 天并发症，其中 81 名 (4%) 患者出现 Clavien ≥3 级并发症。在倾向评分调整后，临床病理学特征得到了很好的平衡。在整个队列中，LND 与 Clavien ≥3 级并发症无统计学显着相关性，尽管任何未达到统计学意义的 Clavien 级并发症的风险增加了约 40%。同样，在 M0 或 M1 患者中单独评估时，LND 与任何 Clavien 等级或 Clavien ≥3 级并发症没有显着相关性。延长的 LND 与任何 Clavien 分级或 Clavien ≥3 级并发症均无显着相关性。LND 与住院时间或估计失血量无关。限制包括回顾性设计。结论 LND 与 Clavien ≥3 级并发症的风险增加没有显着相关性，尽管它可能与轻微并发症的风险适度增加有关。在没有增加发病率的情况下，LND 可能在 RCC 管理中起主要分期作用是合理的。患者总结 肾细胞癌淋巴结清扫与主要并发症发生率的增加无关。