Extension of survival by resection of asynchronous renal cell carcinoma metastases to mediastinal lymph nodes

Objective: The aim of this study was to determine whether or not resection of isolated mediastinal lymph node renal cell carcinoma metastases confers a survival advantage, as compared with patients with stage IV disease. Patients and Methods: We retrospectively reviewed the charts of all patients with renal cell carcinoma whose histologic specimens were evaluated at our institution from January 1, 2000, through December 31, 2006. Using Kaplan-Meier estimates, we compared the survival of patients who underwent resection of asynchronous mediastinal lymph node metastases with that of patients with stage IV disease. Results: During the 7-year study period, of the 386 patients with renal cell carcinoma who were evaluated at our institution, 9 underwent resection of asynchronous mediastinal lymph node metastases. After primary tumor resection and before diagnosis of asynchronous mediastinal lymph node metastases, all patients completed chemotherapy, cytokine therapy, or tumor vaccination; 3 underwent radiotherapy. The median age at resection of mediastinal lymph nodes was 57.7 years (range, 39.7-81.2). The median time from primary tumor resection to mediastinal lymph node resection was 2.8 years (range, 0.5-23.3). In all, 4 patients underwent resection of metastases via thoracotomy and 5, via thoracoscopy. The median number of mediastinal lymph nodes pathologically evaluated was 7 (range, 2-28); the median number of positive mediastinal lymph nodes per patient was 1.5 (range, 1-3). We found no surgical complications. The median survival after resection of metastases (3.2 years) was significantly longer (P = .021) than for other patients with stage IV disease at our institution (1.1 years). Conclusions: Resection of renal cell carcinoma mediastinal lymph node metastases is safe, appears to extend survival, and should be considered an important component of treating patients with renal cell carcinoma who have asynchronous mediastinal lymph node metastases.