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Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection : An extended follow-up study

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Title: Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection : An extended follow-up study
Authors: Matsumoto, Ryuji Browse this author →KAKEN DB
Abe, Takashige Browse this author →KAKEN DB
Takada, Norikata Browse this author
Minami, Keita Browse this author
Harabayashi, Toru Browse this author →KAKEN DB
Nagamori, Satoshi Browse this author
Hatanaka, Kanako C. Browse this author
Yamashiro, Katsushige Browse this author
Kikuchi, Hiroshi Browse this author →KAKEN DB
Osawa, Takahiro Browse this author →KAKEN DB
Maruyama, Satoru Browse this author →KAKEN DB
Shinohara, Nobuo Browse this author →KAKEN DB
Keywords: Urothelial carcinoma
Upper urinary tract
Lymph node dissection
Relapse pattern
Issue Date: Dec-2020
Publisher: Elsevier
Journal Title: Urologic oncology
Volume: 38
Issue: 12
Start Page: 933.e13
Publisher DOI: 10.1016/j.urolonc.2020.05.013
Abstract: Objectives: This study investigated the relapse pattern and oncologic outcomes after laparoscopic nephroureterectomy with template-based lymph node dissection (LND) in patients with clinically node-negative (cN0) upper urinary tract urothelial carcinoma. The frequency of lymph node metastasis, including micrometastases, was also evaluated. Methods and materials: A total of 105 patients with cTa-3N0M0 upper urinary tract urothelial carcinoma were analyzed, all of whom underwent regional LND during laparoscopic nephroureterectomy. Of those patients, 96 (91%) underwent complete LND in accordance with an anatomical template-based rule. We collected patient characteristics, pathological data, and follow-up data from medical charts. Micrometastases were assessed by pan-cytokeratin immunohistochemistry. Nonurothelial recurrence-free survival and cancer-specific survival were estimated using the Kaplan-Meier method. Results: The median number of lymph nodes removed was 12 (range, 1-59). Lymph node metastasis was identified by routine pathological examination in 7 (7/105, 6.7%) patients. Pan-cytokeratin immunohistochemistry revealed micrometastases in 5 additional patients (pNmicro +: 5/105, 4.8%). Nonurothelial disease recurrence was observed in 21 (20%) patients at a median of 10 months (range: 1- 33) after surgery. Distant metastasis was dominant (15/105, 14.3%), followed by locoregional recurrence (5/105, 4.8%) and both (1/105, 0.95%). The 5-year nonurothelial recurrence-free survival rates were 84.8% for pN0, 53.3% for pNmicro+, and 19.1% for pN+ (3-sample log-rank test, P < 0.0001). The 5-year cancer-specific survival rates were 95.0% for pN0, 53.3% for pNmicro+, and 23.8% for pN+ (P < 0.0001). Conclusions: Our observation showed that template-based LND could contribute to precise disease staging and better local disease control probably by eliminating nodal disease, compared with previous studies. The survival impact and ideal management of pNmicro+ disease should be evaluated in a larger cohort. (C) 2020 The Authors. Published by Elsevier Inc.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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