title: Outcome of regional lymphadenectomy in accordance with primary tumor location on laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract: a prospective study.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: 1 Department of Urology, Hokkaido University Graduate School of Medicine , Sapporo, Japan .
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Norikata
authors.initials: N
authors.lastname: Takada
authors.forename: Ryuji
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osawa
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Keita
authors.initials: K
authors.lastname: Minami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagamori
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Hatanaka
authors.forename: Yuka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*