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
| Autor: | Yoshihito Higashi, Hitoshi Yamada, Toru Kanno, Satoshi Funada, Go Kobori, Seiji Moroi, Masashi Kubota, Takao Haitani, Takashi Okada |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Nephroureterectomy Inferior vena cava 03 medical and health sciences Retroperitoneal lymph node dissection 0302 clinical medicine Ureter Humans Medicine Retroperitoneal space Kidney Pelvis Prospective Studies Retroperitoneal Space Laparoscopy Ureteral neoplasm Aged Carcinoma Transitional Cell medicine.diagnostic_test Ureteral Neoplasms business.industry medicine.disease Kidney Neoplasms Surgery medicine.anatomical_structure medicine.vein 030220 oncology & carcinogenesis Lymph Node Excision Female Lymph business Renal pelvis |
| Zdroj: | Urology. 112:85-91 |
| ISSN: | 0090-4295 |
| Popis: | Objective To describe our en bloc technique of retroperitoneal lymph node dissection (RPLND) during retroperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma and evaluate perioperative outcomes. Methods From 2002 to 2015, 114 patients with urinary tract urothelial carcinoma located at the pelvis or upper or middle ureter underwent retroperitoneal laparoscopic radical nephroureterectomy at 2 institutions. Performance of RPLND began in February 2009. The template of RPLND included the renal hilar and para-aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (right side). After incising Gerota fascia longitudinally, the aorta (left side) or inferior vena cava (right side) was exposed, and the lymphatic and surrounding fatty tissue in the template and kidney was dissected in a single monoblock. Preoperative data were compared between the RPLND and the no-RPLND groups using propensity score matching. Results In total, 32 matched pairs were evaluated. RPLND was successfully accomplished without open conversion in all cases. The operative time in the RPLND group was approximately 100 minutes longer than that in the no-RPLND group, but there was no significant difference in the blood loss volume or complication rate. The pathologic stages were similar in both groups. The mean number of retrieved lymph nodes was 10.7 (range 3-27), and lymph node metastasis was detected in 5 (16%) cases. Conclusion Retroperitoneoscopic en bloc RPLND permits complete and radical removal of the lymphatic tissue contained in the RPLND template. Our en bloc technique is a safe and feasible procedure with comparable blood loss and complication rates. |
| Databáze: | OpenAIRE |
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