Extended Lymph Node Sampling During Surgery for Pediatric Renal Tumors Concerning for Malignancy Does Not Increase Post-Operative Complication Rates.

PURPOSE: Although Children's Oncology Group renal tumor protocols mandate lymph node sampling (LNS) during extirpative surgery for pediatric renal tumors, LNS is often omitted or low yield. Concerns over morbidity associated with extended LNS have led to hesitancy in adopting a formal LNS template. We hypothesized that complications in children undergoing LNS for renal tumors would be rare, and not associated with the number of LNs sampled.

METHODS: A single-institution, retrospective review of patients aged 0-18yrs undergoing extirpative renal surgery with LNS for a suspected malignancy between 2005-2019 was performed. Patients with 0 or an unknown number of LNs sampled or <150 days of follow-up were excluded. A "clinically significant" (CS) complication was defined as any Clavien-Dindo complication ≥ III, small bowel obstruction (SBO), chylous ascites, organ injury, or wound infection. The number of LNs sampled and its influence on the odds of experiencing a CS complication was examined.

RESULTS: 144 patients met inclusion criteria. Median patient age was 38 months. Twenty-one patients (15%) had a CS complication, the most common of which was ileus/SBO (n = 16). In a multivariable analysis, increased LN yield was not found to influence the odds of experiencing a CS complication ( P = .6).

CONCLUSIONS: In this cohort, there was no statistically significant difference in CS complications in patients who underwent more extensive LNS during surgery for a suspected malignant pediatric renal tumor. Future studies on protocol adherence, staging accuracy, and survival trends using a LNS template in these patients should be performed.