Prospective clinical trial of the feasibility and safety of modified retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract urothelial carcinoma

Study Type – Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Very little is known about the safety and potential oncological benefit of performing a retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract tumours. This study is the first clinical trial to prospectively validate the safety and feasibility of a retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract tumours. The onus is now on the scientific community at large to conduct adequately powered multicentre clinical trials to evaluate the potential oncological benefit it may impart to patients with upper tract tumours. OBJECTIVE • To determine the safety and feasibility of modified retroperitoneal lymph node dissection (RPLND) at the time of radical nephroureterectomy (RNU). PATIENTS AND METHODS • Between 2009 and 2011, 20 patients with suspected upper urinary tract urothelial carcinoma (UUT‐UC) underwent open (n= 10), laparoscopic (n= 4), or robot‐assisted (n= 6) RNU with modified RPLND. • Demographic, clinical and pathological data, histological nodal status, peri‐operative complications and recurrence data were collected. RESULTS • On histopathological review, one patient had a benign angioma and was excluded from the final data analysis. Of the remaining 19 patients, 10 had pTa, five had pT1, one had pT2, and three pT3 disease. • The mean (range) lymph node count was 7 (2–17), with one patient having pathologically proven lymph node metastasis. The mean (range) operating time was 279 (146–500) min. The mean EBL was 396 (100–1100) mL, with the mean (range) hospital stay 7.1 (4–18) days. The mean (range) duration of follow‐up after surgery was 12 (2–24) months. • Overall, nine patients developed postoperative complications, which included eight minor (Clavien Grade I‐II) and one major complication (Clavien grade IIIb). The major complication was a postoperative chylous lymphatic leak requiring surgical exploration. CONCLUSION • The present results indicate that modified RPLND during RNU for UUT‐UC is a feasible procedure with acceptable morbidity. A larger prospective clinical trial is needed to adequately assess its potential therapeutic benefit.