Prospective clinical trial of the feasibility and safety of modified retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract urothelial carcinoma

Abstract

OBJECTIVE: • To determine the safety and feasibility of modified retroperitoneal lymph node dissection (RPLND) at the time of radical nephroureterectomy (RNU). PATIENTS AND METHODS: • Between 2009 and 2011, 20 patients with suspected upper urinary tract urothelial carcinoma (UUT-UC) underwent open ( n = 10), laparoscopic ( n = 4), or robot-assisted ( n = 6) RNU with modified RPLND. • Demographic, clinical and pathological data, histological nodal status, perioperative complications and recurrence data were collected. RESULTS: • On histopathological review, one patient had a benign angioma and was excluded from the final data analysis. Of the remaining 19 patients, 10 had pTa, five had pT1, one had pT2, and three pT3 disease. • The mean (range) lymph node count was 7 (2 - 17), with one patient having pathologically proven lymph node metastasis. The mean (range) operating time was 279 (146 - 500) min. The mean EBL was 396 (100 - 1100) mL, with the mean (range) hospital stay 7.1 (4 - 18) days. The mean (range) duration of follow-up after surgery was 12 (2 - 24) months. • Overall, nine patients developed postoperative complications, which included eight minor (Clavien Grade I-II) and one major complication (Clavien grade IIIb). The major complication was a postoperative chylous lymphatic leak requiring surgical exploration. CONCLUSION: • The present results indicate that modified RPLND during RNU for UUT-UC is a feasible procedure with acceptable morbidity. A larger prospective clinical trial is needed to adequately assess its potential therapeutic benefit. © 2012 BJU International.