Templated lymph node sampling during surgery for pediatric renal tumors increases lymph node yield and does not increase long-term postoperative complication rates.
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PURPOSE: We previously demonstrated that higher yield during lymph node sampling for suspected renal malignancy did not increase clinically significant complications. We evaluated the incidence of complications over a longer follow-up period as well as when random sampling versus formal "templated" lymph node dissection was performed. We also compared overall lymph node yields between techniques. METHODS: A single-institution, retrospective review of patients aged 0-18 years old undergoing extirpative renal surgery with lymph node sampling for a suspected malignancy between 2005 and 2019 was performed. Intraoperative and postoperative complications within 4 years of surgery were recorded and categorized based on the Clavien-Dindo scale. The number of lymph nodes sampled and its influence on the odds of experiencing a clinically significant complication was examined. The Wilcoxon rank sum test was used for continuous variables and Chi-Square analysis was used for categorical variables. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to build a complete case multivariable model. Sex, race, age at surgery, tumor laterality, tumor thrombus, overall disease stage, preoperative chemotherapy, nephrectomy type, tumor size, estimated blood loss (EBL), and intraoperative fluid volume were included. P-values were calculated at a significance threshold of 0.05. RESULTS: One hundred forty-one patients met study criteria. Templated lymph node dissection was associated with higher median lymph node yield [12 (8-20) vs. 6 (3-10), p < 0.001]. There were 22 (15.6%) clinically significant complications. There were no observed statistically significant differences in sex (p = 0.060), patient age (p = 0.5), overall disease stage (p = 0.2), presence of tumor thrombus (p > 0.9), tumor size (p = 0.7), or exposure to perioperative chemotherapy (p = 0.088). Tumor laterality (p = 0.003), EBL (p = 0.001), and intraoperative fluid volume resuscitation (p = 0.007) demonstrated unadjusted statistically significant associations with postoperative clinically significant complications. There was no observed statistically significant association between sampling approach and surgical complications (OR, 1.32; 95% CI, 0.47-3.60; p = 0.59). CONCLUSIONS: Templated lymph node sampling in children with suspected renal malignancy is not associated with clinically significant complications after extended follow-up and demonstrated increased lymph node yield. We hope that this data will further inform future studies into whether templated sampling can increase surgical protocol adherence and improve staging accuracy.