Korean J Urol.  2007 Apr;48(4):371-375. 10.4111/kju.2007.48.4.371.

Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Comparison with Open Nephroureterectomy

• Lee JN
• Kim HT
• Kwon TG

• KMID: 1997102
• DOI: http://doi.org/10.4111/kju.2007.48.4.371

Abstract

PURPOSE
Laparoscopic nephroureterectomy (LNUx) has recently been done to treat patients with upper tract transitional cell carcinoma. We retrospectively evaluated the efficacy and safety of LNUx in comparison with open nephroureterectomy (ONUx).
MATERIALS AND METHODS
Between May 2001 and March 2006, a total of 51 patients underwent radical nephroureterectomy for upper tract transitional cell carcinoma, including 22 LNUx and 29 ONUx. LNUx was performed transperitoneally and the ureteral end with a bladder cuff was transected through a 5-7cm modified Gibson incision. All the specimens were extracted intact. The patients' characteristics and the perioperative and followup data were analyzed retrospectively.
RESULTS
LNUx was successfully performed in all the patients without open conversion. The analgesic requirement was lower, and the average time to oral intake and the length of hospitalization were shorter for LNUx than for ONUx. The average operative time, estimated blood loss and complications were not statistically different between the LNUx and ONUx. The mean follow-up periods of the LNUx and ONUx were 13.7 and 30.0 months, respectively. Both groups were similar in regard to bladder recurrence, local recurrence and distant metastasis. There was no sign of the trocar site or peritoneal seeding after LNUx.
CONCLUSIONS
Our results suggest that LNUx is an acceptable alternative to ONUx for treating upper urinary tract transitional cell carcinoma. However, a longer follow-up period and comparative studies to the standard open techniques will be required.

Keyword

Carcinoma, transitional cell; Laparoscopic surgery; Nephrectomy

MeSH Terms

Carcinoma, Transitional Cell*
Follow-Up Studies
Hospitalization
Humans
Laparoscopy
Neoplasm Metastasis
Nephrectomy
Operative Time
Recurrence
Retrospective Studies
Surgical Instruments
Ureter
Urinary Bladder
Urinary Tract*

Reference

1. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991. 146:278–282.

2. Lim DJ, Kim HH, Moon YT, Park YY, Yang SK, Yoon SJ, et al. Endourologic procedures and laparoscopic surgery in urology trainning hospitals: the report of nationwide survey. Korean J Urol. 2004. 45:714–719.

3. Guazzoni G, Cestari A, Montorsi F, Bellinzoni P, Centemero A, Naspro R, et al. Laparoscopic treatment of adrenal diseases: 10 years on. BJU Int. 2004. 93:221–227.

4. Micali S, Peluso G, De Stefani S, Celia A, Sighinolfi MC, Grande M, et al. Laparoscopic adrenal surgery: new frontiers. J Endourol. 2005. 19:272–278.

5. Cheung MC, Lee YM, Rindani R, Lan H. Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma. ANZ J Surg. 2005. 75:593–596.

6. Ono Y, Hattori R, Gotoh M, Yoshino Y, Yoshikawa Y, Kamihira O. Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already? Curr Opin Urol. 2005. 15:75–78.

7. Cummings KB. Nephroureterectomy: rationale in the management of transitional cell carcinoma of the upper urinary tract. Urol Clin North Am. 1980. 7:569–578.

8. Gill IS, Sung GT, Hobart MG, Savage SJ, Meraney AM, Schweizer DK, et al. Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience. J Urol. 2000. 164:1513–1522.

9. Jeong YR, Park HY, Lee TY. The early experience of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinomas. Korean J Urol. 2003. 44:28–33.

10. Ko YL, Jang DS, Kim CS. Comparison of retroperitoneoscopic and open nephroureterectomy for upper tract transitional cell carninoma. Korean J Urol. 2004. 45:1111–1115.

11. Kim DW, Ryu DS, Oh TH. Initial experience of retroperitoneal laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. Korean J Urol. 2005. 46:382–387.

12. Chung HJ, Chiu AW, Chen KK. Retroperitoneoscopy assisted nephroureterectomy for the management of upper tract urothelial cancer. Min Inv Ther. 1996. 5:266–271.

13. Keeley FX Jr, Tolley DA. Laparoscopic nephroureterectomy: making management of upper-tract transitional-cell carcinoma entirely minimally invasive. J Endourol. 1998. 12:139–141.

14. Salomon L, Hoznek A, Cicco A, Gasman D, Chopin DK, Abbou CC. Retroperitoneoscopic nephroureterectomy for renal pelvic tumors with a single iliac incision. J Urol. 1999. 161:541–544.

15. Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM, Clayman RV. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 2000. 163:1100–1104.

16. Wagle DG, Moore RH, Murphy GP. Primary carcinoma of the renal pelvis. Cancer. 1974. 33:1642–1648.

17. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998. 52:594–601.

18. Martin SF, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol. 2005. 173:395–400.

19. Bariol SV, Stewart GD, Mcneill SA, Tolley DA. Oncological control following laparoscopic nephroureterectomy: 7-year outcome. J Urol. 2004. 172:1805–1808.

20. Gill IS, Soble JJ, Miller SD, Sung GT. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol. 1999. 161:430–434.

21. McDougall EM, Clayman RV, Elashry O. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 1995. 154:975–980.

22. Hattori R, Yoshino Y, Gotoh M, Katoh M, Kamihira O, Ono Y. Laparoscopic nephroureterectomy for transtional cell carcinoma of renal pelvic and ureter: nagoya experience. Urology. 2006. 67:701–705.