Prospective clinical trial of the feasibility and safety of modified retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract urothelial carcinoma, "Beyond the Abstract," by Philippe E. Spiess, MD, MSc, FACS, FRCS(C)

BERKELEY, CA (UroToday.com) - The present phase II clinical trial is the first to validate in a prospective manner the safety and feasibility of performing a modified retroperitoneal lymph node dissection (RPLND) at the time of radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC), with our major complication rate (Clavien grade 3 or more) being only 5.3%.

"The gauntlet is passed to national and international collaborative groups/societies to perform a large prospective clinical trial to adequately assess the potential oncological benefit of performing a modified RPLND at the time of RNU for UUT-UC."

Our study was performed for urothelial cancer and establishes a baseline for the reported complication of a concomitant lymph node dissection conducted in this setting and in a prospective designed clinical trial. In our series, most complications were minor (Clavien Grade I-II), including 1 of the 2 cases of post-operative chylous ascites (which resolved with conservative measures). There were no statistical differences in the complication rate with regards to the surgical approach selected in an individual case. In addition, it is interesting to note that there were no differences in the mean of length of stay following surgery irrespective of the surgical approach, which we suspect results from a similar return in bowel function and inability to be rapidly advanced to a regular diet following surgery, regardless of the approach.

In the present series, 50% of the patients had superficial tumors and only 4 (20%) had invasive tumors (pT2- T3). One of our patients had a nodal metastasis at the time of modified RPLND but only a minute focus of high-grade T1 UUT-UC was present in the final RNU pathological specimen. The low incidence of nodal metastasis in our series could hence result from the majority of our patients exhibiting low grade and non-invasive tumors.

In conclusion, the present prospective phase II clinical trial demonstrates that a modified RPLND at the time of RNU and bladder cuff excision is feasible with acceptable morbidity. The gauntlet is passed to national and international collaborative groups/societies to perform a large prospective clinical trial to adequately assess the potential oncological benefit of performing a modified RPLND at the time of RNU for UUT-UC. 


Written by:

Philippe E. Spiess, MD, MSc, FACS, FRCS(C) as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Department of Genitourinary Oncology
Moffitt Cancer Center
12902 Magnolia Drive, Office 12538
Tampa, FL 33612, USA 


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

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