論文

査読有り 国際誌
2015年3月

Outcome of regional lymphadenectomy in accordance with primary tumor location on laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract: a prospective study.

Journal of endourology
  • Takashige Abe
  • ,
  • Norikata Takada
  • ,
  • Ryuji Matsumoto
  • ,
  • Takahiro Osawa
  • ,
  • Ataru Sazawa
  • ,
  • Satoru Maruyama
  • ,
  • Kunihiko Tsuchiya
  • ,
  • Toru Harabayashi
  • ,
  • Keita Minami
  • ,
  • Satoshi Nagamori
  • ,
  • Kanako C Hatanaka
  • ,
  • Yuka Tanaka
  • ,
  • Nobuo Shinohara
  • ,
  • Katsuya Nonomura

29
3
開始ページ
304
終了ページ
9
記述言語
英語
掲載種別
DOI
10.1089/end.2014.0369

PURPOSE: To determine the appropriate template of regional lymph node dissection (LND) at the time of laparoscopic nephroureterectomy (LNU) for patients with clinically node- negative urothelial carcinoma of the upper urinary tract. PATIENTS AND METHODS: This prospective study included 45 patients undergoing LND with LNU in accordance with our prospective rules regarding the area of LND. Perioperative, pathologic, and follow-up data were collected. Micrometastasis in lymph nodes (LNs) was later evaluated by immunohistochemistry (IHC). Recurrence-free survival (RFS) was calculated with the Kaplan-Meier method. RESULTS: The median number of LNs removed was 14 (range 1-33). One patient with pT3 disease had node metastasis based on routine pathologic examination, and IHC revealed micrometastases in two additional patients (pT2 in one and pT3 in one). Therefore, 15% (3/20) of patients with ≥pT2 disease had node disease. After surgery, six patients experienced minor complications (Grade 1 or 2), and Grade 5 gastrointestinal bleeding after aspiration pneumonia developed in one elderly male patient on the 45th postoperative day, which was not considered to be associated with LND. At the last follow-up, lung metastasis developed in four patients (pT1 in one, pT2 in one, and pT3 in two), and presacral lymph node metastasis developed in one patient with a lower ureteral tumor (pT2), which was not included in our prospective template for a lower ureteral tumor. LN recurrence within/ near the LND area was not observed in patients with pelvic/upper ureteral carcinoma. The 2-year nonurothelial RFS rate was 84%. CONCLUSIONS: We consider that the present template represents regional LNs for patients with clinically node-negative pelvic/upper ureteral carcinoma, while presacral LNs may be incorporated into the regional LND template for patients with clinically node-negative lower ureteral carcinoma.

リンク情報
DOI
https://doi.org/10.1089/end.2014.0369
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/25255401

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