To understand uncertainties and knowledge gaps regarding lymphatic drainage in renal tumours, we performed two prospective studies to demonstrate regional lymph node (LN) drainage with sentinel lymph node (SN) imaging and biopsy. Here, we report the technique and perioperative safety of retroperitoneal SN dissection with different surgical approaches.
73 patients from the two trials were included in the analysis. Patients had cT1-2N0M0 renal tumours (</=10 cm) and underwent nephrectomy (46/63%) or partial nephrectomy (27/37%) with SN dissection after intraoperative detection with a γ-probe, and locoregional LND. Twenty-nine of 73 patients had open surgery, 27/73 laparoscopic and 17/73 robot-assisted laparoscopic (partial)nephrectomy. Surgery time, intraoperative adverse events (AE) according to CTCAE 5.0, and postoperative AE according to Clavien-Dindo (CD) were retrospectively assessed.
There were no grade ≥3 intraoperative CTCAE 5.0 AEs. Postoperative AE rate was 16.4% of which 7 (9.6%) were CD grade 1-2 and 5 (6.8%) were 3a grade complications. There were no statistically significant differences between presence of AE, CD grade and surgical modality (p=0.27 and p=0.13, respectively). Blood loss was a median of 550 ml (IQR 200-900ml) and 225 (IQR 42-751ml) for partial nephrectomy (PN) and radical nephrectomy, respectively. Length of the procedure was 170 min (IQR 149-184min), 155 min (IQR 130-177min) 180 min (IQR 162-202min) in open, laparoscopic and robot-assisted procedures, respectively.
The addition of retroperitoneal SN dissection combined with locoregional LND during (partial)nephrectomy is surgically safe. Complication rate is low and does not differ between surgical approaches.
Urology. 2019 Apr 30 [Epub ahead of print]
Teele Kuusk, Oscar Brouwer, Niels Graafland, Kees Hendricksen, Maarten Donswijk, Axel Bex
Department of Urology, The Netherlands Cancer Institute, Postbus 90203, 1006 BE, Amsterdam, The Netherlands., Department of Nuclear Medicine, The Netherlands Cancer Institute, Postbus 90203, 1006 BE, Amsterdam, The Netherlands., Department of Urology, The Netherlands Cancer Institute, Postbus 90203, 1006 BE, Amsterdam, The Netherlands. Electronic address: .