Standardized and Simplified Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Urothelial Carcinoma of the Upper Ureter or Renal Pelvis: En Bloc Resection Technique

Kanno, Toru; Kobori, Go; Kubota, Masashi; Funada, Satoshi; Haitani, Takao; Okada, Takashi; Higashi, Yoshihito; Moroi, Seiji; Yamada, Hitoshi

doi:10.1016/j.urology.2017.11.001

Cited by 11 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Here, we describe a novel technique of SELNUx. Additionally, the importance of LND during NUx has been shown in several recent retrospective studies 14–18 . Our novel procedure also enables technically feasible LND with reliable surgical orientation.…”

Section: Introductionmentioning

confidence: 68%

Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning

et al. 2020

View full text Add to dashboard Cite

Objective To describe a novel technique allowing laparoscopic nephroureterectomy with bladder cuff excision and lymphadenectomy, in a complete supine position, without patient repositioning. Methods Between January 2016 and October 2018, 20 consecutive patients with upper urinary tract urothelial carcinoma underwent supine extraperitoneal laparoscopic nephroureterectomy. The patients were placed in the complete supine position. A 4‐cm pararectal skin incision was made and the extraperitoneal space was developed. We used a unique port placement that permits complete access for nephroureterectomy, bladder cuff excision and concomitant lymphadenectomy. Operative parameters and pathological data were analyzed. Results The median age was 70 years (range 49–88 years), the mean operative time was 234 min (range 175–293 min) and the mean estimated blood loss was 67 mL (range 50–200 mL). There were no intraoperative complications, and no patients required transfusion or open conversion. The median number of removed lymph nodes was 10; only one patient had node metastasis. The total operative time and time for nephroureterectomy were significantly longer in the first 10 patients (first group) than in the second 10 patients (second group). Times required for bladder cuff excision and lymphadenectomy did not differ between the two groups. Conclusions Our novel technique, which enables completion of the entire procedure of nephrouretectomy with bladder cuff excision and lymphadenectomy in the supine position without patient repositioning, is safe and minimizes operative time while maintaining oncological efficacy. We believe this approach might become a standard option for patients with upper urinary tract urothelial carcinoma.

show abstract

Section: Introductionmentioning

confidence: 68%

Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Amongst these records, 22 were included in the qualitative synthesis, and 12 cohort studies in 14 records were included in the quantitative analysis. These studies are reported in Table 1 [5,[9][10][11][12][13][14][15][16][17][18][19][20][21]. Five studies reported a description of their associated LND templates and these are presented in Table 2 [9, [14][15][16][17][18][19].…”

Section: Resultsmentioning

confidence: 99%

“…The lymph nodes being excised also allows proper histological assessment and this may be important for staging purposes. However, the role of [9] Left side: left renal hilar to longitudinal midline of aorta Right side: right renal hilar to longitudinal midline of aorta Caudal border: level of the aortic bifurcation Kanno et al [14] Left side: renal hilar and para-aortic LN Right side: renal hilar, paracaval, retrocaval, and intra-aortocaval LN Cranial border: 1-2 cm higher than the renal hilum Caudal border: level of the aortic bifurcation Kondo et al, [15] Kondo et al [ [19] Renal pelvis or upper ureter: from para-aorta to vena cava Cranial border: renal hilum Caudal border: IMA Mid-ureter: from para-aorta to vena cava Cranial border: renal hilum Caudal border: bifurcation of the common iliac artery Lower ureter: Ipsilateral pelvic nodes on the ipsilateral side (Greater extent carried out when multiple tumours were located in different areas of the ureter)…”

Section: Discussionmentioning

confidence: 99%

“…Further LND-specific complications reported by Kondo et al [18] included numbness of the thigh, lymphorrhoea and chyle fistula, although lymphorrhoea was also observed in one patient from the non-LND group. When we included laparascopic and robotassistedLNDs only, there was also no significant differencebetween the LND and non-LND groups for postoperativecomplications [9,14].…”

Section: Postoperative Complicationsmentioning

confidence: 96%

“…While open procedures are common, laparoscopic and robot-assisted LNDs are emerging procedures. A study by Kanno et al [14] assessed intraoperative characteristics and found a significantly longer operative time and nonsignificantly lower estimated blood loss during laparoscopic LND in radical NU for upper ureteric and renal pelvic cancer. A nationwide study, by Pearce et al [20] in the USA, reported a higher intraoperative complication rate in the LND group (4.34%) when compared to the non-LND group (3.76%); however, the results were not statistically significant.…”

Section: Intraoperative Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Lymph node dissection for upper tract urothelial carcinoma: A systematic review

Chan

Wong

Yuan

et al. 2020

Arab Journal of Urology

View full text Add to dashboard Cite

Objective: To perform a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, investigating the role of lymph node dissection (LND) during nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC); focussing on survival and complication outcomes. Methods: A comprehensive systematic search was completed using a combination of Medical Subject Headings terms and keywords related to UTUC and LND on multiple databases. Metaanalyses were performed when outcomes were reported under the same definition in two or more studies. Where meta-analysis was not possible, outcomes were reviewed in a narrative manner. Results: A total of 21 studies were included in the qualitative analysis and 11 cohort studies in the quantitative analysis. Our review did not detect significant improvement in recurrence-free survival (RFS) (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.41-1.92), cancer-specific survival (CSS) (HR 0.89, 95% CI 0.54-1.46) and overall survival (OS) (HR 1.10, 95% CI 0.93-1.30). However, when focussing on studies only including patients with pT2/pT3 UTUC, not performing LND significantly worsened RFS (HR 2.83, 95% CI 1.72-4.66). Reports of removing more than eight lymph nodes may also provide prognostic benefits in pN0 patients. The performance of LND was not associated with a higher rate of postoperative complications (risk ratio 1.06, 95% CI 1.00-1.13). Conclusion: Overall, LND did not provide additional benefit in RFS, CSS and OS. However, there was a potential benefit in RFS in patients with muscle-invasive and advanced UTUC. LND was also not associated with increased risks of postoperative complications.

show abstract

Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians

et al. 2022

View full text Add to dashboard Cite

Standardized and Simplified Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Urothelial Carcinoma of the Upper Ureter or Renal Pelvis: En Bloc Resection Technique

Cited by 11 publications

References 17 publications

Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning

Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning

Lymph node dissection for upper tract urothelial carcinoma: A systematic review

Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians

Contact Info

Product

Resources

About