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Sentinel Lymph Node Biopsy in Renal Tumors: Surgical Technique and Safety

Kuusk, T; Brouwer, O; Graafland, N; Hendricksen, K; Donswijk, M; Bex, A; (2019) Sentinel Lymph Node Biopsy in Renal Tumors: Surgical Technique and Safety. Urology , 130 pp. 186-190. 10.1016/j.urology.2019.04.026. Green open access

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Abstract

Objective: To understand uncertainties and knowledge gaps regarding lymphatic drainage in renal tumours, we performed two prospective studies to demonstrate regional lymph node (LN) drainage with sentinel lymph node (SN) imaging and biopsy. Here, we report the technique and perioperative safety of retroperitoneal SN dissection with different surgical approaches. / Methods: 73 patients from the two trials were included in the analysis. Patients had cT1-2N0M0 renal tumours (</=10 cm) and underwent nephrectomy (46/63%) or partial nephrectomy (27/37%) with SN dissection after intraoperative detection with a γ-probe, and locoregional LND. Twenty-nine of 73 patients had open surgery, 27/73 laparoscopic and 17/73 robot-assisted laparoscopic (partial)nephrectomy. Surgery time, intraoperative adverse events (AE) according to CTCAE 5.0, and postoperative AE according to Clavien-Dindo (CD) were retrospectively assessed. / Results: There were no grade ≥3 intraoperative CTCAE 5.0 AEs. Postoperative AE rate was 16.4% of which 7 (9.6%) were CD grade 1-2 and 5 (6.8%) were 3a grade complications. There were no statistically significant differences between presence of AE, CD grade and surgical modality (p=0.27 and p=0.13, respectively). Blood loss was a median of 550 ml (IQR 200-900ml) and 225 (IQR 42-751ml) for partial nephrectomy (PN) and radical nephrectomy, respectively. Length of the procedure was 170 min (IQR 149-184min), 155 min (IQR 130-177min) 180 min (IQR 162-202min) in open, laparoscopic and robot-assisted procedures, respectively. / Conclusions: The addition of retroperitoneal SN dissection combined with locoregional LND during (partial)nephrectomy is surgically safe. Complication rate is low and does not differ between surgical approaches.

Type: Article
Title: Sentinel Lymph Node Biopsy in Renal Tumors: Surgical Technique and Safety
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.urology.2019.04.026
Publisher version: https://doi.org/10.1016/j.urology.2019.04.026
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Lymphoscintigraphy, Morbidity, Nephrectomy, Renal cell carcinoma, SPECT/CT, Sentinel lymph node
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10074358
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