title: Trends of lymphadenectomy in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy.
abstract: BACKGROUND
  To evaluate temporal trends in the delivery and extent of lymphadenectomy (LND) in radical nephroureterectomy (RNU) performed in upper tract urothelial carcinoma (UTUC) patients.
  
  
  METHODS
  We evaluated a multi institutional collaborative database composed by 1512 consecutive patients diagnosed with UTUC treated with RNU between 1990 and 2016. Year of surgery were grouped in five periods: 1990-1996, 1997-2002, 2003-2007, 2008-2012 and 2013-2016. Data about LND were available for all patients and numbers of nodes removed and positive were reported by dedicate uropathologists. The Mann-Whitney and Chi square tests were used to compare the statistical significance of differences in medians and proportions, respectively.
  
  
  RESULTS
  Five hundred forty-five patients (36.0%) received a concomitant LND while 967 (64.0%) did not; 41.9% of open RNU patients received a concomitant LND compared to 24.4% of laparoscopic RNU patients. The rate of concomitant LND increased with time in the overall, laparoscopic and open RNU patients (all p < 0.03). Patients treated with open RNU also had an increasing likelihood to receive an adequate concomitant LND (p < 0.001) while those undergoing a laparoscopic approach did not (p = 0.1). Patients treated with concomitant LND had a median longer operative time of 20 min (p = 0.01). There were no differences in perioperative outcomes and complications between patients who received a concomitant LND and those who did not (p > 0.1).
  
  
  CONCLUSIONS
  Although an increased trend was observed, most patients treated with RNU did not receive LND. Surgeons using a laparoscopic RNU were less likely to perform a concomitant LND, and when done, they remove less nodes.
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.|Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.|Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Foerster
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abufaraj
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
authors.forename: Francesco
authors.initials: F
authors.lastname: Soria
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris 6, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris 6, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Mondor Assistance Publique des Hôpitaux de Paris, INSERM U955Eq07, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: De la Taille
authors.affiliation: Department of Urology, Hopital Pontchaillou, CHU Rennes, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, 35000, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Herout
authors.affiliation: Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Manfred Peter
authors.initials: MP
authors.lastname: Wirth
authors.affiliation: Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.affiliation: Department of Urology, Jagiellonian University, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlosta
authors.affiliation: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bandini
authors.affiliation: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: 12Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Simone
authors.affiliation: 12Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.affiliation: 12Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romeo
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, University of Montreal, Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
authors.affiliation: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. sfshariat@gmail.com.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. sfshariat@gmail.com.|Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. sfshariat@gmail.com.|Department of Urology, Weill Cornell Medical College, New York, NY, USA. sfshariat@gmail.com.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000074682:Nephroureterectomy / Q000379:methods / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery
keywords: Lymph node metastases; Lymphadenectomy; Radical nephroureterectomy; UTUC; Upper tract urothelial carcinoma