Comparison of Retroperitoneoscopic and Open Nephroureterectomy for Upper Tract Transitional Cell Carcinoma

Ko, Young Lok; Jang, Dae Soo; Kim, Chul Sung

Abstract

PURPOSE: To evaluate the efficacy and safety of retroperitoneoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and the ureter.
MATERIALS AND METHODS
A total of 30 patients underwent nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 16 underwent a retroperitoneoscopic nephroureterectomy(RNU) and 14 an open nephroureterectomy(ONU). After the retroperitoneal radical nephrectomy had initially been performed, a 5-6cm modified Gibson incision was then created to allow dissection of the lower ureter and bladder cuff and extraction of the intact specimen. A retrospective chart review was performed and the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay and complications assessed in both surgical groups.
RESULTS
The RNU was superior to the ONU group with regard to blood loss(240.6+/-103.1 versus 519.3+/-62.3ml, p<0.05), analgesic requirement (118.8+/-24.7 versus 240+/-26mg, p<0.05), ambulation time(21.5+/-3.7 versus 36.3+/-5.1 hours, p<0.05), interval to resume oral intake(34+/-3.3 versus 58+/-7.1 hours, p<0.05), and hospital stay(5.5+/-1.4 versus 10.9+/-3.9days, p<0.05). Complications developed in 6 and 14 of the RNU and ONU patients, but all of complications in both group were resolved with conservative management. The mean operating time of the RNU group was longer than that of the ONU group(270.6+/-53.2 versus 233.6+/-20.2 mins, p<0.05). The operating time of the initial 8 patients in the RNU group(311.3+/-38.8 mins) was significantly longer than that of the ONU group(p<0.05). However, the difference in the operating times between the final 8 patients in the RNU group(230+/-7.5 mins) and those in the ONU group were not significant(p>0.05).
CONCLUSIONS
A retroperitoneoscopic nephroureterectomy is better tolerated by patients than an open nephroureterectomy as the surgery for an upper tract transitional cell carcinoma, and is also an efficacious alternative to open surgery. However, a long-term oncological evaluation will be required.