Abstract：
To describe the detailed perioperative complications and their management after retroperitoneal lymph node dissection with retroperitoneal laparoscopic radical nephroureterectomy for patients with upper tract urothelial carcinoma at three institutions.
Retroperitoneal lymph node dissection was performed on patients with upper tract urothelial carcinoma located at the pelvis and/or upper or middle ureter, and its template included the renal hilar and para-aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (right side). The lymph nodes and kidneys were removed en bloc. The primary endpoint was postoperative complication rates, and the secondary endpoints were intraoperative findings and chylous leakage management. The associations of retroperitoneal lymph node dissection with postoperative complications were examined using logistic regression with propensity score techniques.
Eighty-eight (31%) and 195 (69%) patients underwent and did not undergo retroperitoneal lymph node dissection, respectively. There was no significant difference in postoperative complications and other perioperative findings in the entire cohort, except for prolonged operation time. Retroperitoneal lymph node dissection was not statistically significantly associated with total and serious complications in propensity score analyses. Postoperative chylous leakage could be conservatively managed even though it is common in patients with retroperitoneal lymph node dissection (14/88 (16%)). The incidence of chylous leakage was significantly lower in patients whose lymphatic vessels were meticulously clipped completely during retroperitoneal lymph node dissection (5.3% vs 24%; P = 0.017).
There was no association between retroperitoneal lymph node dissection with laparoscopic radical nephroureterectomy and postoperative complications. However, chylous leakage is often observed after retroperitoneal lymph node dissection and careful management is highly required. The use of clips during retroperitoneal lymph node dissection is recommended to minimize chylous leakage risk.
Retroperitoneal lymph node dissection was performed on patients with upper tract urothelial carcinoma located at the pelvis and/or upper or middle ureter, and its template included the renal hilar and para-aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (right side). The lymph nodes and kidneys were removed en bloc. The primary endpoint was postoperative complication rates, and the secondary endpoints were intraoperative findings and chylous leakage management. The associations of retroperitoneal lymph node dissection with postoperative complications were examined using logistic regression with propensity score techniques.
Eighty-eight (31%) and 195 (69%) patients underwent and did not undergo retroperitoneal lymph node dissection, respectively. There was no significant difference in postoperative complications and other perioperative findings in the entire cohort, except for prolonged operation time. Retroperitoneal lymph node dissection was not statistically significantly associated with total and serious complications in propensity score analyses. Postoperative chylous leakage could be conservatively managed even though it is common in patients with retroperitoneal lymph node dissection (14/88 (16%)). The incidence of chylous leakage was significantly lower in patients whose lymphatic vessels were meticulously clipped completely during retroperitoneal lymph node dissection (5.3% vs 24%; P = 0.017).
There was no association between retroperitoneal lymph node dissection with laparoscopic radical nephroureterectomy and postoperative complications. However, chylous leakage is often observed after retroperitoneal lymph node dissection and careful management is highly required. The use of clips during retroperitoneal lymph node dissection is recommended to minimize chylous leakage risk.
摘要：
描述三个机构的上尿路尿路上皮癌患者腹膜后腹腔镜根治性肾输尿管切除术后腹膜后淋巴结清扫术的详细围手术期并发症及其处理。
对位于骨盆和/或输尿管上部或中部的上尿路上皮癌患者进行腹膜后淋巴结清扫。其模板包括肾门和主动脉旁淋巴结（左侧）和肾门，paracaval,后腔静脉,和主动脉腔内淋巴结（右侧）。全部切除淋巴结和肾脏。主要终点是术后并发症发生率，次要终点是术中发现和乳糜渗漏管理。使用倾向评分逻辑回归技术检查腹膜后淋巴结清扫与术后并发症的关系。
88例（31%）和195例（69%）患者接受但未接受腹膜后淋巴结清扫术，分别。在整个队列中，术后并发症和其他围手术期发现没有显着差异，除了延长的操作时间。在倾向评分分析中，腹膜后淋巴结清扫与总并发症和严重并发症无统计学意义。即使在腹膜后淋巴结清扫术患者中很常见（14/88（16％）），术后乳糜漏也可以保守治疗。在腹膜后淋巴结清扫术中精心完全夹住淋巴管的患者，乳糜漏的发生率显着降低（5.3％vs24％；P=0.017）。
腹膜后淋巴结清扫术与腹腔镜肾癌根治术与术后并发症无相关性。然而,腹膜后淋巴结清扫后经常观察到乳糜漏，高度需要小心处理。建议在腹膜后淋巴结清扫术中使用夹子，以最大程度地减少乳糜渗漏的风险。
对位于骨盆和/或输尿管上部或中部的上尿路上皮癌患者进行腹膜后淋巴结清扫。其模板包括肾门和主动脉旁淋巴结（左侧）和肾门，paracaval,后腔静脉,和主动脉腔内淋巴结（右侧）。全部切除淋巴结和肾脏。主要终点是术后并发症发生率，次要终点是术中发现和乳糜渗漏管理。使用倾向评分逻辑回归技术检查腹膜后淋巴结清扫与术后并发症的关系。
88例（31%）和195例（69%）患者接受但未接受腹膜后淋巴结清扫术，分别。在整个队列中，术后并发症和其他围手术期发现没有显着差异，除了延长的操作时间。在倾向评分分析中，腹膜后淋巴结清扫与总并发症和严重并发症无统计学意义。即使在腹膜后淋巴结清扫术患者中很常见（14/88（16％）），术后乳糜漏也可以保守治疗。在腹膜后淋巴结清扫术中精心完全夹住淋巴管的患者，乳糜漏的发生率显着降低（5.3％vs24％；P=0.017）。
腹膜后淋巴结清扫术与腹腔镜肾癌根治术与术后并发症无相关性。然而,腹膜后淋巴结清扫后经常观察到乳糜漏，高度需要小心处理。建议在腹膜后淋巴结清扫术中使用夹子，以最大程度地减少乳糜渗漏的风险。
