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Bekku K, Kawada T, Yanagisawa T, Karakiewicz PI, Shariat SF. Role of lymphadenectomy during primary surgery for kidney cancer. Curr Opin Urol 2023; 33:294-301. [PMID: 37014778 PMCID: PMC10256307 DOI: 10.1097/mou.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Lymph node dissection (LND) during radical nephrectomy (RN) for renal cell carcinoma (RCC) is not considered as a standard. The emergence of robot-assisted surgery and effective immune checkpoint inhibitors (ICI) in recent years may change this and lymph node (LN) staging has become easier and has a clinical impact. In this review, we aimed to reconsider the role of LND today. RECENT FINDINGS Although the extent of LND has still not been well established, removal of more LN seems to provide better oncologic outcomes for a select group of patients with high-risk factors such as clinical T3-4. Adjuvant therapy using pembrolizumab has been shown to improve disease free survival if complete resection of metastatic lesions as well as the primary site is obtained in combination. Robot assisted RN for localized RCC has been widespread and the studies regarding LND for RCC has been recently appeared. SUMMARY The staging and surgical benefits and its extent of LND during RN for RCC remains unclear, but it is becoming increasingly important. Technologies that allow an easier LND and adjuvant ICI that improve survival in LN-positive patients are engaging the role of LND, a procedure that was needed, but almost never done, is now indicated sometimes. Now, the goal is to identify the clinical and molecular imaging tools that can help identify with sufficient accuracy who needs a LND and which LNs to remove in a targeted personalized approach.
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Affiliation(s)
- Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pierre I. Karakiewicz
- Cancer Prognostic and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Romao RLP, van der Steeg AFW, Malek M, Irtan S, Gow K, Ghandour K, Biasoni D, Davidoff A, Pachl M. Technical advances in the surgical management of Wilms tumors in children. Pediatr Blood Cancer 2023; 70 Suppl 2:e30267. [PMID: 36815577 DOI: 10.1002/pbc.30267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
Surgery is one of the cornerstones of Wilms tumor treatment. In this article, we present technical advancements that are finding their way into the armamentarium of pediatric cancer surgeons. We discuss the current approaches, challenges, opportunities, and future directions of minimally invasive surgery (laparoscopic and robotics), image-guided surgery, and fluorescence-guided surgery. Furthermore, we discuss the use of intraoperative ultrasonography, as well as the use of new techniques to improve the quality of lymph node sampling.
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Affiliation(s)
- Rodrigo L P Romao
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alida F W van der Steeg
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marcus Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, Sorbonne Université, Armand-Trousseau Hospital - APHP, Paris, France
| | - Kenneth Gow
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Khalil Ghandour
- Department of Surgery, King Hussein Cancer Foundation and Center, Amman, Jordan
| | - David Biasoni
- Department of Pediatric Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Andrew Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Max Pachl
- Department of Pediatric Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
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Kuusk T, Klatte T, Zondervan P, Lagerveld B, Graafland N, Hendricksen K, Capitanio U, Minervini A, Stewart GD, Ljungberg B, Horenblas S, Bex A. Outcome after resection of occult and non-occult lymph node metastases at the time of nephrectomy. World J Urol 2021; 39:3377-3383. [PMID: 33634323 DOI: 10.1007/s00345-021-03633-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/05/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE There is sparse evidence on outcomes of resected occult LN metastases at the time of nephrectomy (synchronous disease). We sought to analyse a large international cohort of patients and to identify clinico-pathological predictors of long-term survival. MATERIALS AND METHODS We collected data of consecutive patients who underwent nephrectomy and LND for Tany cN0-1pN1 and cM0-1 RCC at 7 referral centres between 1988 and 2019. Patients were stratified into four clinico-pathological groups: (1) cN0cM0-pN1, (2) cN1cM0-pN1(limited, 1-3 positive nodes), (3) cN1cM0-pN1(extensive, > 3 positive nodes), and (4) cM1-pN1. Overall survival (OS) was estimated using the Kaplan-Meier method, and associations with all-cause mortality (ACM) were evaluated using Cox models with multiple imputations. RESULTS Of the 4370 patients with LND, 292 patients with pN1 disease were analysed. Median follow-up was 62 months, during which 171 patients died. Median OS was 21 months (95% CI 17-30 months) and the 5-year OS rate was 24% (95% CI 18-31%). Patients with cN0cM0-pN1 disease had a median OS of 57 months and a 5-year OS rate of 43%. 5-year OS (median OS) decreased to 29% (33 months) in cN1cM0-pN1(limited) and to 23% (23 months) in cN1cM0-pN1(extensive) patients. Those with cM1-pN1 disease had the worst prognosis, with a 5-year OS rate of 13% (9 months). On multivariable analysis, age (p = 0.034), tumour size (p = 0.02), grade (p = 0.02) and clinico-pathological group (p < 0.05) were significant predictors of ACM. CONCLUSION Depending on clinico-pathological group, grade and tumour size, 5-year survival of patients with LN metastases varies from 13 to 43%. Patients with resected occult lymph node involvement (cN0/pN1 cM0) have the best prognosis with a considerable chance of long-term survival.
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Affiliation(s)
- Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK.,Department of Urology, Renal Cancer Unit, Royal Free Hospital, London, UK
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Patricia Zondervan
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Niels Graafland
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, Renal Cancer Unit, Royal Free Hospital, London, UK. .,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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