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Template-based lymphadenectomy reduces the risk of regional lymph node recurrence among patients with upper/middle ureteral cancer

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Abstract

Background

Our previous nonrandomized prospective study showed that template-based lymphadenectomy improved survival among patients with renal pelvic cancer but not among patients with ureteral cancer. However, regional node sites vary according to the tumor’s location in relation to the ureter. Therefore, this retrospective study examined the therapeutic role of lymphadenectomy for ureteral cancer according to tumor location.

Methods

Between January 1988 and September 2015, we performed nephroureterectomy for 154 patients with nonmetastatic urothelial carcinoma of the ureter at two Japanese institutions. The tumors’ locations were classified as the lower ureter or the upper/middle ureter (before the cranial crossing of the common iliac artery). The appropriate regional nodes were identified based on our previous mapping study. Dissection was classified as complete lymphadenectomy (all regional sites were dissected), incomplete lymphadenectomy (not all sites were dissected), or no lymphadenectomy. We focused the analyses on patients with ≥pT2 disease to clarify the effect of the lymphadenectomy.

Results

Among the 48 patients with upper/middle ureteral cancer, recurrence-free and cancer-specific survival were significantly higher in the complete lymphadenectomy group (vs. the incomplete or no lymphadenectomy groups). However, there were no differences in recurrence-free and cancer-specific survivals among the 56 patients with lower ureteral cancer. In the patients with upper/middle ureteral cancer, multivariate analysis revealed that template-based lymphadenectomy was independently associated with a reduced risk of cancer-specific mortality.

Conclusions

Template-based lymphadenectomy has a therapeutic benefit for treating patients with upper/middle ureteral cancer but not for treating patients with lower ureteral cancer.

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Acknowledgments

The authors thank Editage for English language editing and Noriko Hata for secretarial work. None of the authors received financial support for the work described herein.

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Authors and Affiliations

  1. Department of Urology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Tsunenori Kondo, Toshio Takagi, Yasunobu Hashimoto, Hirohito Kobayashi, Junpei Iizuka, Kenji Omae, Kazuhiko Yoshida & Kazunari Tanabe

  2. Department of Urology, Wakayama Medical University, Wakayama, Japan

    Isao Hara & Yoshiki Kodama

Authors
  1. Tsunenori Kondo
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  2. Isao Hara
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  3. Toshio Takagi
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  4. Yoshiki Kodama
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  5. Yasunobu Hashimoto
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  6. Hirohito Kobayashi
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  7. Junpei Iizuka
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  8. Kenji Omae
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  9. Kazuhiko Yoshida
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  10. Kazunari Tanabe
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Corresponding author

Correspondence to Tsunenori Kondo.

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Conflict of interest

T Kondo received honoraria from Pfizer, Bayer, and Novartis. All other authors have no conflicts of interest to declare.

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Kondo, T., Hara, I., Takagi, T. et al. Template-based lymphadenectomy reduces the risk of regional lymph node recurrence among patients with upper/middle ureteral cancer. Int J Clin Oncol 22, 145–152 (2017). https://doi.org/10.1007/s10147-016-1024-7

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  • DOI: https://doi.org/10.1007/s10147-016-1024-7

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