Laparoscopic and robotic nephroureterectomy: does lymphadenectomy have an impact on the clinical outcome?

Nessn H Azawi, Kasper Drimer Berg, Andreas Key Milan Thamsborg, Claus Dahl, Jan Viberg Jepsen, Bjarne Kroman-Andersen, Johan Poulsen, Helle Handler Petersen, L Henning Olsen, Jørgen Bjerggaard Jensen

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Abstrakt

PURPOSE: To evaluate the effect of lymphadenectomy (LND) in conjunction with nephroureterectomy on cancer-specific mortality (CSM) and overall survival (OS) for patients with muscle-invasive UTUC.

METHODS: A retrospective, multicenter study of patients with UTUC, clinical stage N0M0, who underwent nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM.

RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy-two patients (62%) had non-muscle-invasive disease (NMID); 105 patients (38%) had muscle-invasive disease (MID). Median time of follow-up was 43.5 months (95% CI 36.0-47.2). For patients with MID, the 5-year cumulative incidence of all-cause mortality and CSM was 73.5% (95% CI 60.4-86.6) and 52.4% (95% CI 38.9-65.9), respectively (p < 0.0001). There was no significant difference in OS between patients with N1 and patients with N0 disease (p = 0.53). The 5-year OS rates were 30.5% (95% CI 6.6-54.4) and 25.7% (95% CI 10.9-40.5), respectively. This study is limited by its retrospective nature. There may also have been bias in the selection of patients undergoing LND.

CONCLUSIONS: Five-year OS and CSM are comparable between patients with N1 and N0 MID. This evidence may support the use of the LND procedure in patients with muscle-invasive UTUC.

OriginalsprogEngelsk
TidsskriftInternational Urology and Nephrology
Vol/bind49
Udgave nummer10
Sider (fra-til)1785–1792
ISSN0301-1623
DOI
StatusUdgivet - 2017

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Citationsformater

Azawi, N. H., Berg, K. D., Thamsborg, A. K. M., Dahl, C., Jepsen, J. V., Kroman-Andersen, B., Poulsen, J., Petersen, H. H., Henning Olsen, L., & Jensen, J. B. (2017). Laparoscopic and robotic nephroureterectomy: does lymphadenectomy have an impact on the clinical outcome? International Urology and Nephrology, 49(10), 1785–1792. https://doi.org/10.1007/s11255-017-1672-1