V-125 Presentación: Vídeo

Laparoscopic Pararetrocaval and Interaortocaval Lymphadenectomy for Upper Tract Urothelial Carcinoma
Miguel Marques Monteiro; Sofia Mesquita; João Vital; Nuno Vinagre; Avelino Fraga; Manuel Oliveira
Centro Hospitalar Universitário de Santo António/Uls Santo António

Template-based lymphadenectomy for upper tract urothelial cancer is recommended for all patients scheduled for Radical Nephroureterectomy due to high-risk non-metastatic UTUC. This approach, even in patients clinically and pathologically node-negative, improves Cancer-Specific Survival in those with muscle-invasive disease and reduces the risk of local recurrence. Minimally invasive surgery may play a crucial role in this context, offering enhanced anatomical detail and improved visualization, however, it presents technical challenges because of great vessels' manipulation with a rising concern regarding complying with oncologic principles and major complications' potential. We reported a case of an eighty-one-year-old man with a history of smoking. He was referred to our department with a history of persistent microscopic hematuria. Physical examination was unremarkable. Urethrocystoscopy and urinary cytology yielded normal results. Computed tomography with delayed phase imaging revealed a filling defect in the right upper mid-ureter with 27 mm of extension and concomitant proximal hydronephrosis. There was no evidence of lymphadenopathy or distant metastases. In November 2023, the patient underwent Radical Nephroureterectomy with pararetrocaval and interaortocaval lymphadenectomy. The procedure was uneventful, with an estimated blood loss of 200 ml. He was discharged after five days. Pathological examination demonstrated an unifocal high-grade urothelial carcinoma obliterating tumor measuring 5.5x1.4mm, staged as pT2N0(0/16). In conclusion, laparoscopic template-based lymphadenectomy for upper tract urothelial carcinoma is a feasible and safe procedure, allowing meticulous dissection and precise removal of lymph nodes while ensuring complete tumor resection and minimizing blood loss and length of stay.