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01-10-2017 | Original Article

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

Authors: Marco Moschini, Beat Foerster, Mohammad Abufaraj, Francesco Soria, Thomas Seisen, Morgan Roupret, Pierre Colin, Alexandre De la Taille, Benoit Peyronnet, Karim Bensalah, Roman Herout, Manfred Peter Wirth, Vladimir Novotny, Piotr Chlosta, Marco Bandini, Francesco Montorsi, Giuseppe Simone, Michele Gallucci, Giuseppe Romeo, Kazumasa Matsumoto, Pierre Karakiewicz, Alberto Briganti, Shahrokh F. Shariat

Published in: World Journal of Urology | Issue 10/2017

Abstract

Introduction

To evaluate temporal trends in the delivery and extent of lymphadenectomy (LND) in radical nephroureterectomy (RNU) performed in upper tract urothelial carcinoma (UTUC) patients.

Methods

We evaluated a multi institutional collaborative database composed by 1512 consecutive patients diagnosed with UTUC treated with RNU between 1990 and 2016. Year of surgery were grouped in five periods: 1990–1996, 1997–2002, 2003–2007, 2008–2012 and 2013–2016. Data about LND were available for all patients and numbers of nodes removed and positive were reported by dedicate uropathologists. The Mann–Whitney and Chi square tests were used to compare the statistical significance of differences in medians and proportions, respectively.

Results

Five hundred forty-five patients (36.0%) received a concomitant LND while 967 (64.0%) did not; 41.9% of open RNU patients received a concomitant LND compared to 24.4% of laparoscopic RNU patients. The rate of concomitant LND increased with time in the overall, laparoscopic and open RNU patients (all p < 0.03). Patients treated with open RNU also had an increasing likelihood to receive an adequate concomitant LND (p < 0.001) while those undergoing a laparoscopic approach did not (p = 0.1). Patients treated with concomitant LND had a median longer operative time of 20 min (p = 0.01). There were no differences in perioperative outcomes and complications between patients who received a concomitant LND and those who did not (p > 0.1).

Conclusion

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.

Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M et al (2015) European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 update. Eur Urol 68:868–879. doi:10.1016/j.eururo.2015.06.044 CrossRefPubMed

O’Brien T, Ray E, Singh R, Coker B, Beard R; British Association of Urological Surgeons Section of Oncology (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60:703–710. doi:10.1016/j.eururo.2011.05.064 CrossRefPubMed

Ito A, Shintaku I, Satoh M, Ioritani N, Aizawa M, Tochigi T et al (2013) Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP Monotherapy Study Group Trial. J Clin Oncol 31:1422–1427. doi:10.1200/JCO.2012.45.2128 CrossRefPubMed

Seisen T, Shariat SF, Cussenot O, Peyronnet B, Renard-Penna R, Colin P et al (2016) Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. doi:10.1007/s00345-016-1764-z PubMed

Xylinas E, Rink M, Margulis V, Faison T, Comploj E, Novara G et al (2013) Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy. J Urol 189:468–473. doi:10.1016/j.juro.2012.09.036 CrossRefPubMed

Roscigno M, Brausi M, Heidenreich A, Lotan Y, Margulis V, Shariat SF et al (2011) Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol 60:776–783. doi:10.1016/j.eururo.2011.07.009 CrossRefPubMed

Chappidi MR, Kates M, Johnson MH, Hahn NM, Bivalacqua TJ, Pierorazio PM (2016) Lymph node yield and tumor location in patients with upper tract urothelial carcinoma undergoing nephroureterectomy affects survival: A U.S. population-based analysis (2004–2012). Urol Oncol 34:531.e15–531.e24. doi:10.1016/j.urolonc.2016.06.013 CrossRef

Capitanio U, Shariat SF, Isbarn H, Weizer A, Remzi M, Roscigno M et al (2009) Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol 56:1–9. doi:10.1016/j.eururo.2009.03.072 CrossRefPubMed

Yang D, Chen Q, Song X, Wang J, Che X, Zhu Z et al (2014) Effect of lymph node dissection on the outcomes of upper tract urothelial carcinomas: a meta-analysis. Expert Rev Anticancer Ther 14:667–675. doi:10.1586/14737140.2014.895670 CrossRefPubMed

10.

Alvarez-Maestro M, Rivas JG, Gregorio SA, Guerin CC, Gomez AT, Ledo JC (2016) Current role of lymphadenectomy in the upper tract urothelial carcinoma. Central Eur J Urol 69. doi:10.5173/ceju.2016.834

11.

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E et al (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115:1224–1233. doi:10.1002/cncr.24135 CrossRefPubMed

12.

Cha EK, Shariat SF, Kormaksson M, Novara G, Chromecki TF, Scherr DS et al (2012) Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 61:818–825. doi:10.1016/j.eururo.2012.01.021 CrossRefPubMed

13.

Yates DR, Hupertan V, Colin P, Ouzzane A, Descazeaud A, Long JA et al (2012) Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer 106:1083–1088. doi:10.1038/bjc.2012.64 CrossRefPubMedPubMedCentral

14.

Walton TJ, Novara G, Matsumoto K, Kassouf W, Fritsche H-M, Artibani W et al (2011) Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int 108:406–412. doi:10.1111/j.1464-410X.2010.09826.x CrossRefPubMed

15.

Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K (2007) Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol 178:1212–1217 (discussion 1217). doi:10.1016/j.juro.2007.05.158

16.

Kondo T, Tanabe K (2012) Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract. Int J Urol 19:710–721. doi:10.1111/j.1442-2042.2012.03009.x CrossRefPubMed

17.

Abe T, Shinohara N, Harabayashi T, Sazawa A, Ishikawa S, Kubota K et al (2008) The role of lymph-node dissection in the treatment of upper urinary tract cancer: a multi-institutional study. BJU Int 102:576–580. doi:10.1111/j.1464-410X.2008.07673.x CrossRefPubMed

18.

Roscigno M, Shariat SF, Margulis V, Karakiewicz P, Remzi M, Kikuchi E et al (2009) Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol 181:2482–2489. doi:10.1016/j.juro.2009.02.021 CrossRefPubMed

19.

Mason RJ, Kassouf W, Bell DG, Lacombe L, Kapoor A, Jacobsen N et al (2012) The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology 79:840–845. doi:10.1016/j.urology.2011.11.058 CrossRefPubMed

20.

Fairey AS, Kassouf W, Estey E, Tanguay S, Rendon R, Bell D et al (2013) Comparison of oncological outcomes for open and laparoscopic radical nephroureterectomy: results from the Canadian Upper Tract Collaboration. BJU Int 112:791–797. doi:10.1111/j.1464-410X.2012.11474.x CrossRefPubMed

21.

Kim HS, Ku JH, Jeong CW, Kwak C, Kim HH (2016) Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol 34:859–869. doi:10.1007/s00345-015-1712-3 CrossRefPubMed

22.

Pearce SM, Pariser JJ, Patel SG, Steinberg GD, Shalhav AL, Smith ND (2016) The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. Urol Oncol Semin Orig Invest 34:121.e15–121.e21. doi:10.1016/j.urolonc.2015.09.008

23.

Gandaglia G, Sammon JD, Chang SL, Choueiri TK, Hu JC, Karakiewicz PI et al (2014) Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era. J Clin Oncol 32:1419–1426. doi:10.1200/JCO.2013.53.5096 CrossRefPubMed

24.

Leow JJ, Reese SW, Jiang W, Lipsitz SR, Bellmunt J, Trinh QD et al (2014) Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol 66:569–576. doi:10.1016/j.eururo.2014.01.029 CrossRefPubMed

25.

Raman JD, Jafri SM (2016) Complications following radical nephroureterectomy. Curr Urol Rep 17:36. doi:10.1007/s11934-016-0595-1 CrossRefPubMed

26.

Raman JD, Lin YK, Shariat SF, Krabbe LM, Margulis V, Arnouk A et al (2016) Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy. BJU Int. doi:10.1111/bju.13556

Title: Trends of lymphadenectomy in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy
Authors: Marco Moschini
Beat Foerster
Mohammad Abufaraj
Francesco Soria
Thomas Seisen
Morgan Roupret
Pierre Colin
Alexandre De la Taille
Benoit Peyronnet
Karim Bensalah
Roman Herout
Manfred Peter Wirth
Vladimir Novotny
Piotr Chlosta
Marco Bandini
Francesco Montorsi
Giuseppe Simone
Michele Gallucci
Giuseppe Romeo
Kazumasa Matsumoto
Pierre Karakiewicz
Alberto Briganti
Shahrokh F. Shariat
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2026-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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