Retroperitoneal lymph‐node dissection for isolated nodal recurrence of renal cell carcinoma after nephrectomy: Contemporary outcomes of a case series

Background and objective: Isolated retroperitoneal lymph-node (RPLN) recurrence after radical nephrectomy (RN) for renal cell carcinoma (RCC) is uncommon, and optimal management remains undefined. This study reports contemporary outcomes of retroperitoneal lymph-node dissection (RPLND) for isolated nodal recurrence, including in patients previously treated with stereotactic ablative body radiotherapy (SABR) or systemic therapy. Methods: A retrospective review was performed of all patients undergoing RPLND for isolated nodal recurrence of RCC between July 2023 and October 2024. Clinical, operative, and pathologic variables were collected, and postoperative complications were graded using the Clavien-Dindo system. Recurrence-free survival (RFS) was calculated from RPLND to recurrence or last follow-up. Results: Eight patients met inclusion criteria. Median age at RPLND was 59.5 years, and six were male. The median interval from RN to RPLND was 29 months. Median operative time was 255 min, estimated blood loss 300 mL, and hospital stay 6.5 days. One patient experienced postoperative complication (Clavien-Dindo IIIa). All specimens confirmed malignancy with negative margins. After a median follow-up of 18 months, three patients (37.5%) recurred, with a mean RFS of 15.3 months. Conclusions: RPLND is a safe and viable option for isolated nodal recurrence of RCC, offering complete resection and oncologic outcomes comparable to historical data, and may serve as an important component of multimodal management.