Category: Laparoscopic/ Robotic: Other

MP30-17 - Robot Assisted Radical Nephroureterectomy with Extended Template Lymphadenectomy for upper tract urothelial carcinoma – An outcome analysis.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Introduction:


Robot-assisted radical nephroureterectomy (RANU) with extended template lymphadenectomy (E-LND) is the leading treatment option for non-metastatic upper tract urothelial carcinoma (UTUC). Due to the rarity of this disease, there is a lack of consensus regarding the best approach and extent of lymphadenectomy. We report the initial outcomes and technique of procedure from a retrospective evaluation of prospectively maintained database of 13 consecutive cases of RANU + E-LND. To the best of our knowledge, our series represents the largest published experience of this procedure from India.


Methods :

RANU was performed in 13 patients with the da Vinci Xi system (including two with simultaneous radical cystectomy). Pelvic and upper ureteric tumors were operated without redocking or repositioning, using the port switching feature. For lower ureteric tumors repositioning of patient and redocking was performed for ensuring completeness of pelvic lymphadenectomy. Extended template lymphadenectomy was performed in all patients as per the templates described in previous studies.


Results :

Median age was 66 years (range 52-75). Median console time and blood losses were 183.5 min (range 156 -270) and 150 cc (range 25-500). Median hospital stay was 3 days (range 2-8). One patient developed paralytic ileus in the postoperative period (Clavien Dindo grade 1). No patient had a positive surgical margin. Median lymph node yield was 21 (range 7- 47). Median follow up was 13 months in which one patient developed metastatic systemic recurrence. All other patients are free of recurrence at last follow up. 


Conclusions :

A robotic approach to radical nephroureterectomy with extended template lymphadenectomy is feasible and safe and does not appear to compromise short-term oncological outcomes as defined by lymph node yields and margin positivity. At the same time, it offers minimally invasive surgery benefits and results in an early patient recovery from this extensive surgery. 

Saurabh RAMESH. Patil

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Bhoiwada, Mumbai, Maharashtra, India

Ashwin Tamhankar

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Mumbai, Maharashtra, India

Surya Ojha

Supervisor, Robotic Surgery program
Max Institute of Healthcare, New Delhi, India
New Delhi, Delhi, India

Puneet Ahluwalia

Consultant, Uro-oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India

Gagan Gautam

Head, Urologic oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India