European temporal trends in the use of lymph node dissection in patients with renal cancer

Capitanio, Umberto; Stewart, Grant D.; Larcher, Alessandro; Ouzaïd, I.; Akdoğan, Bülent; Roscigno, Marco; Marszalek, Martin; Dell’Oglio, Paolo; Salagierski, Maciej; Volpe, Alessandro; Mir, M.; Kriegmair, Maximilian C.; Terrone, Carlo; Brookman-May, S.; Montorsi, Francesco; Klatte, Tobias

doi:10.1016/j.ejso.2017.07.016

Cited by 21 publications

(11 citation statements)

References 19 publications

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“…This may be due to the surgeon's technical concerns about laparoscopically excising nodal tissue adjacent to the major vessels. Furthermore, retroperitoneal lymphadenopathy usually indicates a high probability of intraoperative adhesion and difficulty in separating the renal pedicle, which is not conducive to a laparoscopic operation (19).…”

Section: Discussionmentioning

confidence: 99%

PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

Liu

Zhang

et al. 2020

Oncol Lett

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The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0-5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required.

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Section: Discussionmentioning

confidence: 99%

PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

Liu

Zhang

et al. 2020

Oncol Lett

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“…In the high-risk group, the survival bene t of LND were on the debate. Some retrospective analyses suggested that patients with high risk factors may bene t from LND [2][3][4][5][6] . Blute et al 2 and Crispen et al 5 found that patients with large tumor size (> 10 cm), high furhman grade, pT3-pT4, coagulative necrosis and sarcomatoid differentiation may bene t from LND.…”

Section: Discussionmentioning

confidence: 99%

“…Blute et al 2 and Crispen et al 5 found that patients with large tumor size (> 10 cm), high furhman grade, pT3-pT4, coagulative necrosis and sarcomatoid differentiation may bene t from LND. Capitanio et al 3,4,6 showed LND in the high-risk population like bulky tumor (> 10 cm), locally advanced or metastatic RCC could improve CSS. However, Feuerstein et al 12 and Gershman et al 13 observed that LND did not improve either CSM or OS across all stages, as well as in patients with increased risk of LN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the high risk RCC, the role of LND is unclear and no prospective study are found. Some retrospective researches were found that LND might be bene cial in patients with high-risk RCC or in cases with unfavourable conditions [2][3][4][5][6] . According to the EAU guideline 7 , LND in localized RCC can add staging information but the survival bene ts are unclear, thus we need further investigations.…”

Section: Introductionmentioning

confidence: 99%

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The role of lymph node dissection in non-metastatic renal cell carcinoma with tumor thrombosis: a retrospective analysis

Ruotao

Chuxiao

Wang

et al. 2020

Preprint

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Background To assess therapeutic value of lymph node dissection (LND) in non-metastatic renal cell carcinoma (RCC) with tumor thrombosis (TT) and identify the prognostic factor in these population. Methods We retrospectively reviewed 128 patients with RCC and TT in our institution from February 2015 to January 2019. The baseline characteristics of LND and no LND group were compared. Kaplan–Meier analysis, univariable and multivariable Cox regression models were used to analyze these population. Results Of 128 patients, 58(45%) underwent LND and 70(55%) without LND. Patients who received LND had significantly higher cN1 rate (64% vs 37%; P = 0.004), longer operation time (357 min vs 307 min; p = 0.002) and longer hospital stay (12.6d vs 9.5d; p = 0.094) than that in no LND group. There were 102 patients (79.7%) received followed up with the median 12 months (IQR:8 ~ 19). Estimated three-year overall survival was worse in LND group (75% vs 90%; p = 0.048) but were not significantly different in subgroup of cN0 and cN1. The overall survival were not significantly different between two groups after adjustment for age, tumor size, surgical approach, tumor thrombosis level and histologic type. Non-CCRCC (HR:4.97; 95%CL:1.56 ~ 15.78; P = 0.006) and occurrence of major complication (HR:3.33; 95%CL:1.05 ~ 10.58; P = 0.041) were the predictors of worse OS while positive lymph node is the only independent predictor of worse OS (HR:5.26; 95%CL:1.28 ~ 21.66; P = 0.021) in these populations after receiving LND. Conclusion In this study, we confirm that LND in non-metastatic RCC with TT was not associated with a survival benefit, even we adjusted for clinic node status. Category like age, tumor size, surgical approach, tumor thrombosis level and histologic type were not a indication for LND. Lymph node positive was identified as an independent poor prognostic factor. Therefore, LND in RCC with TT should be considered as a staging procedure rather than therapeutic one.

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“…A study from EORTC showed 4% positive lymph nodes in cN0M0 patients, though with no survival benefit for extended LND (eLND). LND was therefore considered a staging procedure for lymph node metastases [194], influencing the current trend towards less use of LND [195].…”

Section: Lymphadenectomy 165mentioning

confidence: 99%

Real-life use of diagnostic biopsies before treatment of kidney cancer: results from a Norwegian population-based study

Beisland

Johannesen

Reisæter

et al. 2017

Scandinavian Journal of Urology

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European temporal trends in the use of lymph node dissection in patients with renal cancer

Abstract: A trend towards lower LND was observed over time for RCC patients who underwent RN or NSS. LND is more frequently performed in younger patients, locally advanced diseases and in case of open surgery.

Cited by 21 publications

References 19 publications

PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

The role of lymph node dissection in non-metastatic renal cell carcinoma with tumor thrombosis: a retrospective analysis

Real-life use of diagnostic biopsies before treatment of kidney cancer: results from a Norwegian population-based study

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