Oncological Outcomes of Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Renal Pelvic or Upper Ureteral Tumors: Matched-Pair Analysis

Kanno, Toru; Kobori, Go; Ito, Katsuhiro; Nakagawa, Hirofumi; Takahashi, Toshifumi; Koterazawa, Shigeki; Takaoka, Naoto; Somiya, Shinya; Nagahama, Kanji; Ito, M.; Megumi, Yuzuru; Higashi, Yoshihito; Moroi, Seiji; Akao, Tetsuyuki; Yamada, Hitoshi

doi:10.1089/end.2022.0103

Cited by 11 publications

(6 citation statements)

References 18 publications

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“…In all cases, LRNU was performed using the retroperitoneal approach in the kidney position, as previously described. 11 The carbon dioxide gas pressure was started at 8 mmHg and increased temporarily to 15 mmHg as needed. The ureter was clipped immediately after clamping the renal vessels, even if tumor was located in the lower ureter.…”

Section: Methodsmentioning

confidence: 99%

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

et al. 2023

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IntroductionThis study aimed to identify preoperative risk factors and create a risk classification for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy in a multi‐institutional cohort.MethodsWe retrospectively analyzed 283 patients who had undergone laparoscopic radical nephroureterectomy for nonmetastatic upper tract urothelial cancer between March 2002 and March 2020. The cumulative incidence of intravesical recurrence for 224 patients without previous or concomitant bladder cancer was examined using multivariate Fine‐Gray competing risks proportional hazards models. A risk stratification model was created to predict subsequent patient outcomes based on the results.ResultsThe median follow‐up duration was 33.3 months, and 71 (31.7%) patients experienced intravesical recurrence. The estimated cumulative incidence of intravesical recurrence at one and 5 years was 23.5% and 36.4%, respectively. In multivariate analysis, the presence of ureter tumors and multiple tumors were shown to be independently significant predictive factors for intravesical recurrence. Based on the results, we classified patients into three risk groups. The cumulative incidence rates of intravesical recurrence within 5 years after surgery were 24.4%, 42.5%, and 66.7% in the low‐, intermediate‐, and high‐risk groups, respectively.ConclusionsWe identified risk factors and created a risk classification model for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy. Based on this model, an individualized surveillance protocol or adjuvant therapy could be provided.

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Section: Methodsmentioning

confidence: 99%

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

et al. 2023

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“…The authors demonstrated that template-based LND affects survival outcomes and is superior to just assessing the number of removed lymph nodes [45]. Since then, several studies have confirmed that performing an anatomical template-based LND is the best approach/concept from a diagnostic and oncologic perspective [46,47,48 ▪ ,49]. A systematic review showed that template-based LND and the level of completeness of LND both improve CSS in patients with muscle-invasive disease and reduce the risk of local recurrence [21].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…A systematic review showed that template-based LND and the level of completeness of LND both improve CSS in patients with muscle-invasive disease and reduce the risk of local recurrence [21]. In addition, Kanno et al [48 ▪ ] recently conducted a multicenter retrospective study to compare oncologic outcomes in patients who underwent template-based LND during RNU and those who did not. After propensity score matching using confounders such as, age, sex, presence of hydronephrosis, and clinical T stage, the authors showed that the estimated 5-year recurrence-free survival was higher in patients who underwent template-based LND (86.8%) compared with those who did not (64.2%) ( P = 0.014) [48 ▪ ].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…In addition, Kanno et al [48 ▪ ] recently conducted a multicenter retrospective study to compare oncologic outcomes in patients who underwent template-based LND during RNU and those who did not. After propensity score matching using confounders such as, age, sex, presence of hydronephrosis, and clinical T stage, the authors showed that the estimated 5-year recurrence-free survival was higher in patients who underwent template-based LND (86.8%) compared with those who did not (64.2%) ( P = 0.014) [48 ▪ ]. Therefore, a template-based LND should be offered to all patients who are planned for RNU for invasive nonmetastatic UTUC.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

Yanagisawa

Kawada

Deimling

et al. 2023

Current Opinion in Urology

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Purpose of reviewAlthough lymph node dissection (LND) during radical nephroureterectomy (RNU) is recommended for highrisk nonmetastatic upper tract urothelial carcinoma (UTUC), adherence to guidelines remains insufficient in clinical practice. Therefore, this review aims to comprehensively summarize the current evidence regarding the diagnostic, prognostic, and therapeutic impact of LND during RNU in UTUC patients. Recent findingsClinical nodal staging using conventional CT scan has low sensitivity (25%) and diagnostic accuracy [area under the curve (AUC): 0.58] in UTUC, suggesting the importance of LND for obtaining accurate Nstaging. Patients with pathological node-positive (pNþ) disease have poor disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) compared with those with pN0. In addition, population-based studies showed that patients who underwent LND improved CSS and OS than those who did not, even in patients who received adjuvant systemic therapy. The number of lymph nodes removed has also been shown to be associated with improved CSS and OS, even in pT0 patients. Template-based LND should be performed as the extent of lymph node is more important than the number of lymph nodes. Robot-assisted RNU may facilitate performing a meticulous LND compared with a laparoscopic approach. Postoperative complications such as lymphatic and/or chylous leakage are increased but adequately manageable. However, the current evidence is not supported by high-quality studies.

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“…We previously reported the outcomes of laparoscopic RNU (LRNU) for UTUC. 6,7 We compared clinical data, postoperative complications, and oncological outcomes of LRNU in the patients with distal UTUC from 2003 to 2019 (Figure 2 and Table 2). The median follow-up period for this LRNU data of was 30.5 months.…”

Section: Materials and Surgical Techniquementioning

confidence: 99%

The useful technique of laparoscopic segmental ureterectomy with ureteral reimplantation for distal upper tract urothelial carcinoma

Koterazawa,

Somiya,

Ito

et al. 2023

Asian J Endoscop Surgery

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Introduction: Segmental ureterectomy (SU) has been proven effective in cases of distal upper tract urothelial carcinoma (UTUC). Nonetheless, SU has been performed infrequently in the real world, and there is no consensus on the preferred surgical technique in laparoscopic surgery. We describe our first experience of laparoscopic segmental ureterectomy (LSU) with psoas hitch ureteral reimplantation. Materials and surgical technique: LSU starts using a fan-shaped, five-port, transperitoneal approach. First, the cancerous ureter segment is clipped to avoid tumor seeding, and then the diseased segment is dissected. Second, the psoas hitch is performed by fixing the external part of the ipsilateral dome of the bladder to the psoas muscle and its tendon. Third, at the top of the bladder, an incision is made in the muscle layer and mucosa. The ureter is then

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Oncological Outcomes of Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Renal Pelvic or Upper Ureteral Tumors: Matched-Pair Analysis

Cited by 11 publications

References 18 publications

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

The useful technique of laparoscopic segmental ureterectomy with ureteral reimplantation for distal upper tract urothelial carcinoma

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