Laparoscopic Radical Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: The Cleveland Clinic Experience

Abstract

In patients with upper tract transitional cell carcinoma who are candidates for radical nephroureterectomy the retroperitoneal laparoscopic approach satisfactorily duplicates established technical principles of traditional open oncological surgery, while significantly decreasing morbidity from this major procedure. Short-term oncological and survival data of the laparoscopic technique are comparable to open surgery. Although long-term followup data are not yet available, it appears that laparoscopic radical nephroureterectomy may supplant open surgery as the standard of care in patients with muscle invasive or high grade upper tract transitional cell carcinoma.

Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: Comparison of Laparoscopic and Open Surgery

“…However, several investigators have recently introduced laparoscopic procedures to radical nephroureterectomy and suggested their benefit for patient recovery with disease control comparable to that of traditional open surgery [4][5][6]. Minor complications after LNU have been reported in 7-40% of patients and major complications in 4.8-8% [4][5][6][7][8][9][10].…”

Hand-Assisted Laparoscopic Nephroureterectomy for Upper Urinary-Tract Transitional-Cell Carcinoma

“…16 In our series of patients, no recurrences occurred in the peritoneal cavity, and there was no delay in the return of bowel function compared with that in a series performed with a retroperitoneoscopic approach. We acknowledge several limitations in this manuscript including the heterogeneity of surgeons performing the ON procedure, the limited cohort size in the HALN group, and the difference in follow-up interval between the 2 surgical groups.…”

Laparoscopy for urological cancers

“…They showed the superiority of laparoscopic surgery for both operative duration (3.7 vs 4.7 h), reduced blood loss (242 vs 696 mL), narcotic analgesic requirements (26 vs 228 mg morphine sulphate), and hospital stay (2.3 vs 6.6 days). With a mean follow-up of 11.1 months for the laparoscopic and 34.4 months for the open group, both groups had similar bladder recurrence rates (23% and 37%, respectively), local or port-site recurrence (none in both groups), and a mortality of 6% (two patients) vs 30% (nine) [44]. After adjusting for the shorter follow-up in the laparoscopic group, there was no difference in either cancerspeci®c survival or crude survival between the groups [44].…”

“…With a mean follow-up of 11.1 months for the laparoscopic and 34.4 months for the open group, both groups had similar bladder recurrence rates (23% and 37%, respectively), local or port-site recurrence (none in both groups), and a mortality of 6% (two patients) vs 30% (nine) [44]. After adjusting for the shorter follow-up in the laparoscopic group, there was no difference in either cancerspeci®c survival or crude survival between the groups [44]. These results for laparoscopic radical nephroureterectomy appear to be encouraging but the two groups in the study were not comparable.…”

“…Gill et al [44] reported the experience in one institution of laparoscopic radical nephroureterectomy, using the retroperitoneal approach in 42 patients and comparing it with 35 patients who underwent open surgery for pathologically con®rmed upper tract TCC. They showed the superiority of laparoscopic surgery for both operative duration (3.7 vs 4.7 h), reduced blood loss (242 vs 696 mL), narcotic analgesic requirements (26 vs 228 mg morphine sulphate), and hospital stay (2.3 vs 6.6 days).…”