Extended pelvic lymph node dissection in bladder carcinoma provides staging and, in selected patients, a survival benefit. Recent studies showed the therapeutic benefit of retroperitoneal lymph node dissection (RPLND) in advanced stage of upper tract urothelial carcinoma (UTUC). Also laparoscopic extended RPLND is still a technical challenge in urology, considering the high rate of severe complications and difficulties in manipulation. In Renji Hospital, laparoscopic extended RPLND at time of nephroureterectomy was performed via an extraperitoneal approach, avoiding interference with abdominal organs and achieving better exposure.The aim of the present study was to determine the safety and feasibility of performing an extraperitoneal laparoscopic extended RPLND at the time of radical nephroureterectomy (RNU) for UTUC in a prospectively collected cohort of patients.

Population

The patients who are clinically diagnosed with upper tract urothelial carcinoma and expected to receive radical nephroureterectomy will be the candidates for this study. They will be informed about this study and told about the pros and cons of extraperitoneal laparoscopic extended RPLND. If they were willing to attend this study, chest CT scan and other imaging method would be used to exclude out the distant metastasis.

Brief Title

Feasibility and Safety of Extraperitoneal Laparoscopic Extended Retroperitoneal Lymph Node Dissection at Time of Nephroureterectomy for Upper Tract Urothelial Carcinoma

Official Title

Prospective Clinical Trial of the Feasibility and Safety of Extraperitoneal Laparoscopic Extended Retroperitoneal Lymph Node Dissection at Time of Nephroureterectomy for Upper Tract Urothelial Carcinoma

Brief Summary

Extended pelvic lymph node dissection in bladder carcinoma provides staging and, in selected<br /> patients, a survival benefit. Recent studies showed the therapeutic benefit of retroperitoneal<br /> lymph node dissection (RPLND) in advanced stage of upper tract urothelial carcinoma (UTUC).<br /> Also laparoscopic extended RPLND is still a technical challenge in urology, considering the<br /> high rate of severe complications and difficulties in manipulation. In Renji Hospital,<br /> laparoscopic extended RPLND at time of nephroureterectomy was performed via an<br /> extraperitoneal approach, avoiding interference with abdominal organs and achieving better<br /> exposure.The aim of the present study was to determine the safety and feasibility of<br /> performing an extraperitoneal laparoscopic extended RPLND at the time of radical<br /> nephroureterectomy (RNU) for UTUC in a prospectively collected cohort of patients.

Detailed Description

Similar to urothelial carcinoma of the bladder (UCB), UTUC can follow routes of metastases to
involve regional lymph nodes. Nodal metastasis is an adverse prognostic indicator and results
in poor outcome, irrespective of the use of systemic chemotherapy or radiation. The ' gold
standard ' treatment for UUT-UC is RNU.

Extended pelvic lymph node dissection in bladder carcinoma provides staging and, in selected
patients, a survival benefit. Recent studies showed the therapeutic benefit of RPLND in
advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of
prospective studies. Thus, the current guideline recommends lymph node dissection for
invasive UCUT on the basis of insufficient evidence. But no prospective studies have
standardized the ideal extent of RPLND or the optimum number of total lymph nodes that should
be removed in patients with UUT-UC. Also more and more interest has been paid to establish
standardized node dissection templates.

Also laparoscopic extended RPLND is still a technical challenge in urology, considering the
high rate of severe complications and difficulties in manipulation. In Renji Hospital,
laparoscopic extended RPLND at time of nephroureterectomy was performed via an
extraperitoneal approach, avoiding interference with abdominal organs and achieving better
exposure.

The aim of the present study was to determine the safety and feasibility of performing an
extraperitoneal laparoscopic extended RPLND at the time of RNU for UTUC in a prospectively
collected cohort of patients.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.