Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection

Abe, Takashige; Kondo, Tsunenori; Harabayashi, Toru; Takada, Norikata; Matsumoto, Ryuji; Osawa, Takahiro; Minami, Keita; Nagamori, Satoshi; Maruyama, Satoru; Murai, Sachiyo; Tanabe, Kazunari; Shinohara, Nobuo

doi:10.1093/jjco/hyy128

Cited by 14 publications

(11 citation statements)

References 22 publications

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“…Logically, there was no significant effect of the surgical approach on recurrence ( p = 0.1) or mortality ( p = 0.1). Similar results are reported by Abe et al [43] on retrospective data from three Japanese academic centers gathering 214 patients cTanyN0M0. They reported a comparable median LN number between the open group and the pure laparoscopic group (12 vs. 11.5).…”

Section: Results—evidence Synthesissupporting

confidence: 90%

“…Concerning the oncological results, the surgical approach does not seem to make any difference in specialized centers. In the Japanese multicenter study from Abe et al [43], comparable oncological results between open and laparoscopic groups including similar five-year RFS (71.7 vs. 74% ( p = 0.7829)), similar CSS (77.8% vs. 80% ( p = 0.8441)), and similar OS (72.8% vs. 75.9% ( p = 0.3456)). There was no difference between the two approaches for pT3–4 tumors.…”

Section: Results—evidence Synthesismentioning

confidence: 90%

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Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Duquesne

Ouzaïd

Loriot

et al. 2019

JCM

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Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.

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Section: Results—evidence Synthesissupporting

confidence: 90%

Section: Results—evidence Synthesismentioning

confidence: 90%

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Duquesne

Ouzaïd

Loriot

et al. 2019

JCM

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“…Notably, lymph node dissection was not routinely performed in our center because the curative role of lymph node dissection for UTUC remains controversial. 31 , 32 Although some previous articles have described better oncological outcomes when lymph node dissection is performed, 33 , 34 more clinical data and research are still needed to prove the role of lymph node dissection in patients with UTUC.…”

Section: Discussionmentioning

confidence: 99%

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Wang

et al. 2020

J Int Med Res

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Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.

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“…One Korean study of 371 patients with locally advanced UTUC who underwent RNU reported that LNU had a significantly unfavorable 5-year CSS (LNU 66.1% vs. ONU 80.2%) and was an unfavorable predictor of overall survival (hazard ratio, 2.5) in pT3-4 stage UTUC (p<0.05), whereas another study have shown other contradictory outcomes [ 6 , 18 ]. However, a Japanese study by Abe et al [ 19 ]. of 83 patients with pT3-4 stage did not find any significant difference between LNU and ONU, which was similar to the findings of a large-numbered study.…”

Section: Discussionmentioning

confidence: 99%

“…These results could be explained by the exclusion of early LNU cases, to account for urologists who had not yet overcome the learning curve of the laparoscopic procedure for UTUC. Owing to improved laparoscopic surgical technology, including retroperitoneal lymph node dissection, urologists are able to master the laparoscopic technique more quickly, easily perform nodal dissection, and patients have reduced surgical morbidity with early recovery and a shorter hospital stay without adverse effects on the prognostic outcomes [ 10 , 12 , 19 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective multicenter comparison of conditional cancer-specific survival between laparoscopic and open radical nephroureterectomy in locally advanced upper tract urothelial carcinoma

Kim

Song

et al. 2021

PLoS ONE

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Background Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%–30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection. Objective This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers. Methods The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups. Results During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival. Conclusion The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.

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Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection

Abstract: We revealed the feasibility of lymph node dissection (LND) with a laparoscopic approach and the equivalent oncological outcome of laparoscopic nephroureterectomy compared with open nephroureterectomy when regional LND is performed.

Cited by 14 publications

References 22 publications

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

A retrospective multicenter comparison of conditional cancer-specific survival between laparoscopic and open radical nephroureterectomy in locally advanced upper tract urothelial carcinoma

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