Teele Kuusk1, Oscar Brouwer1, Niels Graafland1, Kees Hendricksen1, Maarten Donswijk2, Axel Bex3. 1. Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. 2. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands. 3. Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: a.bex@nki.nl.
Abstract
OBJECTIVE: To understand uncertainties and knowledge gaps regarding lymphatic drainage in renal tumors, we performed 2 prospective studies to demonstrate regional lymph node (LN) drainage with sentinel lymph node (SN) imaging and biopsy. Here, we report the technique and perioperative safety of retroperitoneal SN dissection with different surgical approaches. METHODS: Seventy three patients from the 2 trials were included in the analysis. Patients had cT1-2N0M0 renal tumors (</=10 cm) and underwent nephrectomy (46/63%) or partial nephrectomy (27/37%) with SN dissection after intraoperative detection with a γ-probe, and locoregional LND. Twenty-nine of 73 patients had open surgery, 27 of 73 laparoscopic, and 17 of 73 robot-assisted laparoscopic (partial) nephrectomy. Surgery time, intraoperative adverse events (AE) according to CTCAE 5.0, and postoperative AE according to Clavien-Dindo (CD) were retrospectively assessed. RESULTS: There were no grade ≥3 intraoperative CTCAE 5.0 AEs. Postoperative AE rate was 16.4% of which 7 (9.6%) were CD grade 1-2 and 5 (6.8%) were 3a grade complications. There were no statistically significant differences between presence of AE, CD grade, and surgical modality (P = .27 and P = .13, respectively). Blood loss was a median of 550 ml (IQR 200-900 ml) and 225 (IQR 42-751 ml) for partial nephrectomy (PN) and radical nephrectomy, respectively. Length of the procedure was 170 minutes (IQR 149-184 minutes), 155 minutes (IQR 130-177 minutes) 180 minutes (IQR 162-202 minutes) in open, laparoscopic, and robot-assisted procedures, respectively. CONCLUSION: The addition of retroperitoneal SN dissection combined with locoregional LND during (partial) nephrectomy is surgically safe. Complication rate is low and does not differ between surgical approaches.
OBJECTIVE: To understand uncertainties and knowledge gaps regarding lymphatic drainage in renal tumors, we performed 2 prospective studies to demonstrate regional lymph node (LN) drainage with sentinel lymph node (SN) imaging and biopsy. Here, we report the technique and perioperative safety of retroperitoneal SN dissection with different surgical approaches. METHODS: Seventy three patients from the 2 trials were included in the analysis. Patients had cT1-2N0M0 renal tumors (</=10 cm) and underwent nephrectomy (46/63%) or partial nephrectomy (27/37%) with SN dissection after intraoperative detection with a γ-probe, and locoregional LND. Twenty-nine of 73 patients had open surgery, 27 of 73 laparoscopic, and 17 of 73 robot-assisted laparoscopic (partial) nephrectomy. Surgery time, intraoperative adverse events (AE) according to CTCAE 5.0, and postoperative AE according to Clavien-Dindo (CD) were retrospectively assessed. RESULTS: There were no grade ≥3 intraoperative CTCAE 5.0 AEs. Postoperative AE rate was 16.4% of which 7 (9.6%) were CD grade 1-2 and 5 (6.8%) were 3a grade complications. There were no statistically significant differences between presence of AE, CD grade, and surgical modality (P = .27 and P = .13, respectively). Blood loss was a median of 550 ml (IQR 200-900 ml) and 225 (IQR 42-751 ml) for partial nephrectomy (PN) and radical nephrectomy, respectively. Length of the procedure was 170 minutes (IQR 149-184 minutes), 155 minutes (IQR 130-177 minutes) 180 minutes (IQR 162-202 minutes) in open, laparoscopic, and robot-assisted procedures, respectively. CONCLUSION: The addition of retroperitoneal SN dissection combined with locoregional LND during (partial) nephrectomy is surgically safe. Complication rate is low and does not differ between surgical approaches.