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Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection
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| Title: | Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection |
| Authors: | Abe, Takashige Browse this author →KAKEN DB | | Kondo, Tsunenori Browse this author | | Harabayashi, Toru Browse this author | | Takada, Norikata Browse this author | | Matsumoto, Ryuji Browse this author | | Osawa, Takahiro Browse this author | | Minami, Keita Browse this author | | Nagamori, Satoshi Browse this author | | Maruyama, Satoru Browse this author →KAKEN DB | | Murai, Sachiyo Browse this author | | Tanabe, Kazunari Browse this author | | Shinohara, Nobuo Browse this author →KAKEN DB |
| Keywords: | urothelial carcinoma | | upper urinary tract | | laparoscopic nephroureterectomy | | open nephroureterectomy | | lymph node dissection |
| Issue Date: | 1-Nov-2018 |
| Publisher: | Oxford University Press |
| Journal Title: | Japanese journal of clinical oncology |
| Volume: | 48 |
| Issue: | 11 |
| Start Page: | 1001 |
| End Page: | 1011 |
| Publisher DOI: | 10.1093/jjco/hyy128 |
| Abstract: | Objective: To assess the number of lymph nodes removed as a surrogate marker of the extent of lymph node dissection, and compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in patients undergoing standardized lymph node dissection. Methods: We retrospectively analyzed the data of 214 cTanyN0M0 patients undergoing radical NU with regional lymph node dissection according to the tumor location. The Kaplan-Meier method and Cox hazards model were utilized for survival analyses, including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Results: A total of 114 patients underwent LRNU and 100 underwent ORNU. There was no significant difference in the pT stage, pN stage, or tumor grade, but distal ureteral tumors were more frequent in the LRNU group. The number of lymph nodes removed did not differ between the two groups [LRNU: 12 (median), ORNU: 11.5, P = 0.3852]. Lymph node metastasis was pathologically identified in 19 patients (8.9%). The 5-year RFS (ORNU: 71.7%, LRNU: 74%, P = 0.7829), CSS (77.8 and, 80%, P = 0.8441) and OS (72.8, and 75.9%, P = 0.3456) did not differ between the two groups. In the sub-analysis of pT3/4 patients (n = 83), there were no significant differences in RFS, CSS, or OS between the two groups, although Kaplan-Meier survival curves were slightly better for those receiving ORNU. In the multivariate model, LRNU was not significantly correlated with a poorer RFS, CSS or OS. Conclusion: Our data support the feasibility of lymph node dissection with a laparoscopic approach and the equivalent oncological outcome of LRNU compared with ORNU when regional lymph node dissection is performed. However, LRNU should be performed after careful patient selection for advanced disease. |
| Rights: | http://creativecommons.org/licenses/by-nc/4.0/ |
| Type: | article |
| URI: | http://hdl.handle.net/2115/72426 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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Submitter: 安部 崇重
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