220P - An outcome analysis of robotassisted radical nephroureterectomy with extended template lymphadenectomy for upper tract urothelial carcinoma

Abstract

BackgroundThe leading treatment option for nonmetastatic upper tract urothelial carcinoma in current era is robotassisted radical nephroureterectomy (RANU) with extended template lymphadenectomy (ELND). Due to the rarity of this disease, there is a lack of consensus regarding the best approach and the extent of lymphadenectomy. We report our technique and its initial outcomes from the retrospective evaluation of a prospectively maintained database of 22 consecutive cases of RANU + ELND. MethodsRANU was performed in 22 patients (including two patients with simultaneous radical cystectomy) with the da Vinci Xi system. Pelvic and upper ureteric tumors were operated without redocking or repositioning, using the port hopping feature. For the lower ureteric tumors, the patient was repositioned and the robot was redocked to ensure completeness of pelvic lymphadenectomy. ELND was performed in all the patients as per the templates described in previous studies. ResultsMedian age was 61.72 years (range 46–76). Median console time and blood loss were 170 min (range 156–270) and 150 cc (range 25–500), respectively. Median hospital stay was 3 days (range 2–8). One patient developed paralytic ileus in the postoperative period (Clavien Dindo Grade 1). None had a positive surgical margin and the median lymph node yield was 22.5 (range 7–47). One patient had a papillary renal cell carcinoma and one patient had no evidence of malignancy in final histopathology report. Median followup was 10.5 months during which one patient developed metastatic systemic recurrence. All other patients were disease free at the last followup.Table220P Demographic profile, intraoperative, and postoperative dataUnlabelled ImageNumber of RANU cases, (n)22Side right:left11:11Location Renal pelvic and upper ureteric Mid ureteric Lower ureteric12 4 6Open conversion1 (only for pelvic part of surgery)Median length of stay (range), days3 (28)Templatebased lymphadenectomy22 (100%)Median lymph node yield (range)22.5 (range 7–47)Margin positivity0%Pathological grade* High grade Low grade12 8Pathological T stage* pTa pT1 pT2 pT31 9 2 8Pathological Lymph node status N0 N117 5Adjuvant chemotherapy6Recurrence1*One patient had a papillary renal cell carcinoma and one patient had no evidence of malignancy in final histopathology report. ConclusionsA robotic approach to radical nephroureterectomy with ELND is feasible and safe and does not appear to compromise the shortterm oncological outcomes as defined by lymph node yields and margin positivity. At the same time, it offers the benefits of minimal invasion and results in swifter patient recovery from this extensive surgery. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.