Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection

Autor: Kazunari Tanabe, Norikata Takada, Satoshi Nagamori, Takashige Abe, Toru Harabayashi, Sachiyo Murai, Takahiro Osawa, Nobuo Shinohara, Satoru Maruyama, Tsunenori Kondo, Ryuji Matsumoto, Keita Minami
Rok vydání: 2018
Předmět:
Male
Cancer Research
030232 urology & nephrology
Kaplan-Meier Estimate
Nephroureterectomy
0302 clinical medicine
Laparoscopy
Lymph node
urothelial carcinoma
Upper urinary tract
Aged
80 and over
open nephroureterectomy
medicine.diagnostic_test
General Medicine
Middle Aged
Progression-Free Survival
laparoscopic nephroureterectomy
medicine.anatomical_structure
Treatment Outcome
Oncology
030220 oncology & carcinogenesis
Female
Original Article
Radiology
Lymph
Adult
medicine.medical_specialty
Urologic Neoplasms
upper urinary tract
lymph node dissection
Dissection (medical)
03 medical and health sciences
medicine
Carcinoma
Humans
Radiology
Nuclear Medicine and imaging
Progression-free survival
Ureteral neoplasm
Aged
Proportional Hazards Models
Retrospective Studies
Carcinoma
Transitional Cell
business.industry
medicine.disease
Multivariate Analysis
Lymph Node Excision
Urothelium
business
Zdroj: Japanese Journal of Clinical Oncology
ISSN: 1465-3621
Popis: We revealed the feasibility of lymph node dissection (LND) with a laparoscopic approach and the equivalent oncological outcome of laparoscopic nephroureterectomy compared with open nephroureterectomy when regional LND is performed.
Objective To assess the number of lymph nodes removed as a surrogate marker of the extent of lymph node dissection, and compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in patients undergoing standardized lymph node dissection. Methods We retrospectively analyzed the data of 214 cTanyN0M0 patients undergoing radical NU with regional lymph node dissection according to the tumor location. The Kaplan–Meier method and Cox hazards model were utilized for survival analyses, including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Results A total of 114 patients underwent LRNU and 100 underwent ORNU. There was no significant difference in the pT stage, pN stage, or tumor grade, but distal ureteral tumors were more frequent in the LRNU group. The number of lymph nodes removed did not differ between the two groups [LRNU: 12 (median), ORNU: 11.5, P = 0.3852]. Lymph node metastasis was pathologically identified in 19 patients (8.9%). The 5-year RFS (ORNU: 71.7%, LRNU: 74%, P = 0.7829), CSS (77.8 and, 80%, P = 0.8441) and OS (72.8, and 75.9%, P = 0.3456) did not differ between the two groups. In the sub-analysis of pT3/4 patients (n = 83), there were no significant differences in RFS, CSS, or OS between the two groups, although Kaplan–Meier survival curves were slightly better for those receiving ORNU. In the multivariate model, LRNU was not significantly correlated with a poorer RFS, CSS or OS. Conclusion Our data support the feasibility of lymph node dissection with a laparoscopic approach and the equivalent oncological outcome of LRNU compared with ORNU when regional lymph node dissection is performed. However, LRNU should be performed after careful patient selection for advanced disease.
Databáze: OpenAIRE
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