Laparoscopic-assisted nephroureterectomy after radical cystectomy for transitional cell carcinoma

Abstract

Renal pelvic transitional cell carcinoma (TCC) accounts for approximately 5%-10% of all renal tumors, and about 5% of all urothelial tumors. 1 These rarely occur before the age of 40, the peak incidence being in the sixth and seventh decade of life. About 30% of the patients who present with upper tract urothelial tumors have extension beyond the renal pelvis or parenchyma at presentation. These patients have a five-year survival rate of less than 5%-10%. However, in patients who present with tumors localized to the urothelium or kidney, the five-year survival rate following total nephroureterectomy ranges between 75% and 100%. 2 Total nephroureterectomy with excision of the bladder cuff is the gold standard for the upper tract transitional cell carcinoma. 3 This is based on many studies which have demonstrated a high incidence (30%-75%) of subsequent tumor recurrence in ureteral stump or around ipsilateral ureteral orifice in patients treated with more conservative procedures. 4,5 Further studies have demonstrated that conservative surgery is acceptable in selected groups of patients. 6,7 With the recent developments in percutaneous, endosurgical and laparoscopic techniques, the conservative approach is being used more often, however, these modalities are not without their associated complications. Laparoscopic nephroureterectomy with cystoscopic resection of ureteric orifice is a procedure which has been used in TCC of the upper urinary tract. We report a case of transitional cell carcinoma recurrence in one of the laparoscopic ports after laparoscopic nephroureterectomy for renal TCC. Case Report A 66-year-old woman presented with a history of frank hematuria. Intravenous urogram showed a filling defect in the left renal pelvis, with the mass causing partial obstruction. Computed tomography (CT) confirmed these findings with no signs of distant spread. There was no radiological evidence of tumor extension beyond the kidney. She underwent laparoscopic nephroureterectomy with transurethral resection of ureteric orifice two years ago. The specimen was not bagged in an endopouch but retrieved intact by extending one of the subcostal ports laterally. No evidence of extrarenal disease was found at surgery. The postoperative course was unremarkable. Histology showed poorly differentiated TCC with invasion of stroma and a small focus of vascular invasion. Resection margins of renal vessels and ureter were clear. Eight months later the patient presented with painful incisional hernia in the peri-umbilical laparoscopic port. Exploration showed a fatty lump in the subcutaneous tissue with a necrotic center, which on histological examination proved to be a metastatic deposit of TCC. A repeat CT scan showed local recurrence in the renal bed and along the ipsilateral psoas muscle. There were also metastases in the liver. She was, therefore, referred for systemic chemotherapy. Discussion Laparoscopic nephrectomy is a recognized procedure in patients with benign disease, but the use of laparoscopy in the treatment of maligna...

Single-Docking Robotic-Assisted Radical Nephroureterectomy in Morbidly Obese Patient Post-Radical Cystectomy With Ileal Conduit: A Case Report

“…Moreover, estimated blood loss among patients ranged from 100 to 250 mL; however, they did not mention the change in hemoglobin level before and after the procedure. In addition, the hospital stay was approximately 11 days, with a minimum of five days [ 4 ].…”

“…In a recent study, the laparoscopic approach of NU possesses a significantly higher safety with lower hospital stay and activity limitations compared to the open technique. On the other hand, NU in a patient who underwent radical cystectomy with an ileal conduit is considered a complex procedure and difficult to approach due to the multiple adhesions and altered anatomy [ 4 ].…”

Segmental ureteroileal conduit resection for the treatment of distal upper urinary tract recurrence of bladder cancer following cystectomy

“…Last but not least, as urothelial carcinoma is a multifocal disease, patients should be willing to follow stringent surveillance. Although patients who underwent segmental ureterectomy were advised to adhere to more-aggressive life-long surveillance, the optimum regimen for upper urinary tract recurrence following radical cystectomy remains controversial [ 20 , 21 ]. The majority of upper urinary tract recurrence was detected based on symptoms rather than radiological or cytological surveillance.…”