腎癌に対するリンパ節郭清術の検討

Abstract

1975年1月～1989年12月に根治的腎摘除術およびリンパ節郭清術をおこなった86例を集計した.1) 15例にリンパ節転移を認めた.2)リンパ節転移陽性率はpT, gradeと有意に相関し, またrapid typeに多かった.3) slow typeではリンパ節転移は局所に限局し, 予後も良好であったので, リンパ節郭清術の治療効果があったと考えられた.rapid typeでは静脈血栓や遠隔転移を有する症例が多く, このような症例ではリンパ節郭清術の意義を見出せない

Between January, 1975 and December, 1989, 86 patients with renal cell carcinoma received radical nephrectomy associated with lymphadenectomy at our institutions. Pathological examination revealed lymph node metastasis in 15 patients (17.4%). The incidence of lymph node metastasis increased in accordance with the aggravation of tumor stage (p less than 0.01) and grade (p less than 0.05). Patients with a rapidly growing tumor showed higher incidence of lymph node metastasis than patients with a slow growing tumor (p less than 0.01). Regional lymph node metastases were found in 3 of the 41 patients with a slow growing tumor. Since these 3 patients are surviving with no evidence of disease for 38.7 months on average, the regional lymphadenectomy was considered to have been effective for their survival. Nine of the 25 patients with a rapid growing tumor had progressive lymph node metastasis. Four of them had apparent tumor thrombi as well as lymph node metastasis, and 2 of them had distant metastasis. These patients showed poor prognosis even after operation. Lymphadenectomy was of no value to the patients with apparent tumor thrombi and/or distant metastasis.