Retroperitoneal lymph node dissection for isolated node recurrence of renal cell carcinoma after nephrectomy: a systematic review.

Abstract

Purpose: Isolated retroperitoneal lymph node recurrence after nephrectomy for renal cell carcinoma (RCC) occurrs in approximately 1-3% of patients. The optimal management of this condition remains undefined. This systematic review aims to evaluate perioperative and oncologic outcomes following retroperitoneal lymph node dissection (RPLND) for isolated nodal recurrence of RCC after nephrectomy.

Methods: A systematic literature search was performed in MEDLINE/PubMed and Embase (January 2000-August 2025) according to PRISMA 2020 guidelines (PROSPERO ID: CRD420251167754). Data extracted included patient demographics, perioperative parameters, and oncologic outcomes. The risk of bias was assessed using the ROBINS-I tool.

Results: Seven retrospective studies published between 2008 and 2022 met inclusion criteria, encompassing 144 patients. Median age ranged from 57 to 65 years, with a predominance of clear-cell histology (60-100%). The median interval between nephrectomy and recurrence was 9.6-25 months. Median operative time ranged from 155 to 271 min, with estimated blood loss between 200 and 575 mL and hospital stay of 2-6 days. Overall complication rates were 26-47%, with major (Clavien ≥ III) complications in approximately 10%. Median recurrence-free or progression-free survival ranged from 9 to 19.5 months, and 5-year cancer-specific survival from 61% to 74%. Adverse prognostic factors included a disease-free interval ≤ 12 months, high-grade tumors, pN1 status, and nodal metastasis > 3 cm.

Conclusions: RPLND is an option for isolated retroperitoneal nodal recurrence of RCC after nephrectomy. Prospective multicentre studies are warranted to define optimal patient selection, the role of minimally invasive techniques, and integration with contemporary systemic immunotherapy.