Marco Moschini1,2,3, Beat Foerster1,3,4, Mohammad Abufaraj1,3, Francesco Soria1,3, Thomas Seisen5, Morgan Roupret5, Pierre Colin6, Alexandre De la Taille7, Benoit Peyronnet8, Karim Bensalah9, Roman Herout10, Manfred Peter Wirth10, Vladimir Novotny10, Piotr Chlosta11, Marco Bandini2, Francesco Montorsi2, Giuseppe Simone12, Michele Gallucci12, Giuseppe Romeo12, Kazumasa Matsumoto13, Pierre Karakiewicz14, Alberto Briganti2, Shahrokh F Shariat15,16,17,18. 1. Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 2. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 3. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 4. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland. 5. Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris 6, Paris, France. 6. Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France. 7. Department of Urology, Centre Hospitalier Universitaire Mondor Assistance Publique des Hôpitaux de Paris, INSERM U955Eq07, Paris, France. 8. Department of Urology, Hopital Pontchaillou, CHU Rennes, Rennes, France. 9. Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, 35000, Rennes, France. 10. Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany. 11. Department of Urology, Jagiellonian University, Krakow, Poland. 12. 12Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 13. Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan. 14. Department of Urology, University of Montreal, Montreal, QC, Canada. 15. Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. sfshariat@gmail.com. 16. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. sfshariat@gmail.com. 17. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. sfshariat@gmail.com. 18. Department of Urology, Weill Cornell Medical College, New York, NY, USA. sfshariat@gmail.com.
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.
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 RNUpatients received a concomitant LND compared to 24.4% of laparoscopic RNUpatients. The rate of concomitant LND increased with time in the overall, laparoscopic and open RNUpatients (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.
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