Trends of lymphadenectomy in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy

Moschini, Marco; Foerster, Beat; Abufaraj, Mohammad; Soria, Francesco; Seisen, Thomas; Rouprêt, Morgan; Colin, P.; Taille, Alexandre de la; Peyronnet, B.; Bensalah, Karim; Herout, Roman; Wirth, Manfred P.; Novotný, Vladimír; Chłosta, P.; Bandini, Marco; Montorsi, Francesco; Simone, Giuseppe; Gallucci, Michele; Romeo, Giuseppe; Matsumoto, Kazumasa; Karakiewicz, Pierre I.; Briganti, Alberto; Shariat, Shahrokh F.

doi:10.1007/s00345-017-2026-4

Cited by 44 publications

(28 citation statements)

References 26 publications

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“…Zargar et al in one of the first experience on RNU already demonstrated the advantages of robotics during lymph node dissection reporting a mean value of 9.4 harvested nodes [24]. Compared to ours, also Moschini et al achieved a similar value of nodes resected during ONU and LNU [25]. Nevertheless, the number of lymph nodes yielded was reported in a low number of studies with a high heterogeneity among the studies (I 2 = 99%).…”

Section: Discussionsupporting

confidence: 40%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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Purpose To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. Methods A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. Results Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI − 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. Conclusions Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined. Keywords Open radical nephroureterectomy • Hand-assisted radical nephroureterectomy • Laparoscopic radical nephroureterectomy • Robotic radical nephroureterectomy • Upper tract urothelial carcinoma Electronic supplementary material The online version of this article (

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Section: Discussionsupporting

confidence: 40%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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“…Consecutive patients were treated with extirpative surgery with curative intent in the form of open or laparoscopic RNU [14][15][16] for non-metastatic (N0-1 M0) high-grade UTUC between 1990 and 2016. Performance and extent of associated lymph node dissection was chosen according to surgeon or patient preference and was not standardized [17,18].…”

Section: Study Populationmentioning

confidence: 99%

Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy

et al. 2019

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Objective To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods We retrospectively analysed data from 1610 patients treated with RNU for clinically non‐metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer‐specific mortality (CSM). Results Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non‐organ‐confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high‐grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub‐hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25–4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86–41.17; P < 0.001). Conclusion We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.

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“…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%

“…Lymph node dissection (LND) can be performed in patients with suspected regional lymph node metastasis for staging purposes. A recent study investigating the trends of LND amongst UTUC patients concluded that LND is performed more regularly during open NU, these patients are also more likely to receive adequate concomitant LND when compared to those undergoing laparoscopic NU [5]. Furthermore, whether routine LND in conjunction with NU for UTUC confers any survival benefit is unknown [3].…”

Section: Introductionmentioning

confidence: 99%

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

Chan

Wong

Yuan

et al. 2020

Arab Journal of Urology

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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.

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Trends of lymphadenectomy in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy

Abstract: Although an increased trend was observed, most patients treated with RNU did not receive LND. Surgeons using a laparoscopic RNU were less likely to perform a concomitant LND, and when done, they remove less nodes.

Cited by 44 publications

References 26 publications

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy

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

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