Significance of number of lymph nodes dissected in laparoscopic nephroureterectomy and lymph node dissection for upper tract urothelial cancer

• Published in: Japanese Journal of Endourology and Robotics Vol. 37; no. 1; pp. 105 - 112
• Main Authors: 山本 致之, 石津谷 祐, 加藤 大悟, 波多野 浩士, 河嶋 厚成, 角田 洋一, 福原 慎一郎, 野々村 祝夫
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Endourology and Robotics 2024; 一般社団法人 日本泌尿器内視鏡・ロボティクス学会
• Subjects: リンパ節郭清数; リンパ節郭清術; 腎盂尿管癌; 腹腔鏡下腎尿管全摘除術
• ISSN: 2436-875X
• DOI: 10.11302/jserjje.37.1_105

Objective : Upper tract urothelial cancer with positive lymph nodes has a poor prognosis, so the diagnosis by lymph node dissection is important. The purpose of this study was to evaluate the outcomes of laparoscopic nephroureterectomy and lymph node dissection.Materials and Methods : We included 151 patients who underwent laparoscopic nephroureterectomy for upper tract urothelial cancer between January 2010 and December 2021 in our hospital. Patients with distant metastasis were excluded. Extravesical recurrence-free survival and cancer-specific survival were evaluated by log-rank test. Risk factors of positive lymph nodes were evaluated by logistic regression analysis.Results : On pT stage, 92 patients (60.9％) had pT2 or less, and 59 (39.1％) had pT3 or more. On pN stage, 109/16/26 (72.2％/10.6％/17.2％) had pN0/pN positive/pNx, respectively. The median number of lymph nodes dissected was 10 (range : 0-33). Patients with pN-positive had significantly poorer prognosis than those with pN0 or pNx ; Median extravesical recurrence-free survival and cancer-specific survival of pN positive patients were 13.9 months and 45.0 months, respectively (both P＜0.001). Multivariate analysis revealed that pN-positive were significantly associated with positive lymphovascular invasion (odds ratio 4.120, P＝0.034) and pT3 or higher (odds ratio 4.344, P＝0.049), and the number of dissected lymph nodes (odds ratio 10.937, P＝0.053) tended to be associated with pN-positive. Conclusion : In lymph node dissection under laparoscopic nephroureterectomy for upper tract urothelial cancer, a high number of lymph nodes dissected tended to be associated with pN-positive, suggesting the importance of lymph node dissection.