To investigate the oncological outcomes and recurrence patterns of clinically node-negative patients with renal pelvic and/or upper or middle ureteral tumors after a template-based retroperitoneal lymph node dissection (RPLND) in conjunction with retroperitoneal laparoscopic radical nephroureterectomy (LRNU).
A total of 283 patients who received LRNU with and without RPLND at three Japanese institutions were enrolled. The template of RPLND included the renal hilar and paraaortic lymph nodes (LNs) (left side) and renal hilar, paracaval, retrocaval, and intra-aortocaval LNs (right side). The LNs and kidneys were removed en bloc. The primary endpoint was set as recurrence-free survival. All RPLND cases were matched one-to-one with no RPLND cases using a propensity score matching approach, and 47 matched pairs were included in analyses.
Compared to the control group, significant differences were not observed in the RPLND group in terms of operation time, blood loss, postoperative complication rate, and pathological findings. The estimated five-year recurrence-free survival was significantly higher in the RPLND group (86.8%) compared to the group without RPLND (64.2%) (p = 0.014). The estimated five-year cancer-specific survival showed a similar tendency; however, it did not reach a statistically significant difference (87.5% vs 71.3%, respectively; p = 0.168). As for the first recurrence site, the RPLND group showed a lower incidence of distant recurrence, while a significant difference was not observed in the rate of regional LN recurrence.
This study suggests that a template-based RPLND in conjunction with retroperitoneal LRNU efficiently improves the recurrence-free survival by reducing distant recurrences.
Journal of endourology. 2022 May 24 [Epub ahead of print]
Toru Kanno, Go Kobori, Katsuhiro Ito, Hiromichi Nakagawa, Toshifumi Takahashi, Shigeki Koterazawa, Naoto Takaoka, Shinya Somiya, Kanji Nagahama, Masaaki Ito, Yuzuru Megumi, Yoshihito Higashi, Seiji Moroi, Toshiya Akao, Hitoshi Yamada
Ijinkai Takeda General Hospital, Urology, 28-1 Moriminami-cho, Ishida Fushimi-ku, Kyoto, Japan, 601-1495; ., Hamamatsu, Japan; ., Ijinkai Takeda General Hospital, Urology, 28-1 ishidamoriminami-cho, fushimi-ku, Kyoto, Kyoto, Japan, 601-1495; ., Rakuwakai Otowa Hospital, Kyoto, Japan; ., Ijinkai Takeda Sogo Byoin, 34791, Urology, Kyoto, Japan; ., Ijinkai Takeda General Hospital, Kyoto, Japan; ., Hamamatsu Rosai Hospital, 38070, Hamamatsu, Shizuoka, Japan; ., Ijinkai Takeda General Hospital, Urology, Kyoto, Japan; ., Rakuwakai Otowa Hospital, 13684, Kyoto, Japan; ., Rakuwakai Otowa Hospital, 13684, Kyoto, Japan; ., Hamamatsu Rosai Hospital, 38070, Hamamatsu, Shizuoka, Japan; ., Kyoto, Japan; ., Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan; ., Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan; ., Ijinkai Takeda General Hospital, Urology, Kyoto, Japan; .