Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma

Liu, Feng; Guo, Wei; Zhou, Xiao‐Yang; Ding, Yudi; Ma, Yanan; Hou, Yi; Kong, Xiangbo; Wang, Zhixin

doi:10.1097/md.0000000000011954

Cited by 26 publications

(33 citation statements)

References 45 publications

(28 reference statements)

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“…There were no differences of minor (12.9% vs. 14.1%) or major complication rate (5.6% vs. 8.3%) observed. Studies revealed a significant reduction of the morphine-equivalents dose and shorter LOS in the laparoscopy group [1].…”

Section: Discussionmentioning

confidence: 93%

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Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Hendri

Yuri

Zulfiqqar

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: The upper urinary tract urothelial carcinoma (UTUC) is a rare urological malignancy. Laparoscopic nephroureterectomy (LNU) is one of the options for minimally invasive surgery for UTUC. It has similar oncological outcomes compared to open nephroureterectomy. One of the techniques developed for specimen extraction is the transvaginal route. Transvaginal specimen extraction has advantages in the reduced risk of complications, faster recovery time, and better end result. CASE PRESENTATION: A 37-year-old woman complained of intermittent pain in her right flank for the past 2 months, with significant weight loss. No other significant symptoms occurred. Her general condition was good with a Karnofsky Performance scale index is 90. In the right periumbilical area, there was a mobile, smooth mass palpated with the size of 10 × 12 cm. There was no tenderness. The patient underwent URS and biopsy of the right ureteral mass with pathological analysis resulting in UTUC. Then, the patient underwent laparoscopic radical nephroureterectomy. CONCLUSION: Although the surgical procedure was safe for the patient and more effective in terms of less morbidity, faster healing time, and better cosmetic appearance, transvaginal extraction of the kidney needs to be further studied, particularly relating to the little experience of this new technique.

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Section: Discussionmentioning

confidence: 93%

“…It accounts for 1-5% of all urological tumors. Radical nephroureterectomy (RNU) with bladder cuff excision is the mainstay treatment for UTUC because of the rapid progression characteristic of UTUC, especially for muscle-invasive and/or high-grade disease [1].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Hendri

Yuri

Zulfiqqar

et al. 2020

Open Access Maced J Med Sci

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“…The laparoscopic approach for the treatment of T1 renal tumors has been accepted as the standard surgical method by the development of laparoscopic devices in addition to the laparoscopic experience. LN has been shown to have advantages such as faster recovery, fewer painkillers, early mobilization, shorter hospital stay and early oral feeding compared to open surgery (5,6). Shorter mean time to normal activity (3.6 versus 8.1 weeks) and shorter mean time to full recovery (8.2 versus 29.3 weeks) have been reported for LN compared to open nephrectomy with similar oncological outcomes (7,8,9,10).…”

Section: Discussionmentioning

confidence: 99%

“…Evolution in minimally invasive treatment techniques has led to laparoscopic surgery, the standard treatment procedure for stage T1 kidney tumors (3,4). Laparoscopic nephrectomy (LN) offers oncological results similar to those of open nephrectomy with the advantages of shorter hospital stay, faster recovery, less pain and blood loss (5,6).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Transperitoneal Simple, Radical and Partial Nephrectomy: A Single Center Experience

Çınar¹,

Demirkıran²,

Bulut³

et al. 2020

jus

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Objective: To present our initial experience on laparoscopic transperitoneal nephrectomies and to report the perioperative and postoperative outcomes in patients with kidney tumor. Materials and Methods: We retrospectively evaluated clinical data, laboratory results and radiological findings of 40 patients who underwent laparoscopic renal surgery performed by a single surgeon in a single center between November 2017 and May 2019. Thoracoabdominopelvic computed tomography was performed in all patients. Results: A total of 40 patients (26 males (65%), 14 females (35%) with a median age of 58.7 years underwent laparoscopic transperitoneal nephrectomy. Sixteen patients underwent laparoscopic simple nephrectomy (LSN) for nonfunctional kidney, 20 patients with solid renal tumors underwent laparoscopic radical nephrectomy (LRN), and four patients underwent laparoscopic partial nephrectomy (LPN) for solid renal mass. The mean operative time was 207.9±79.1, 218.9±57.5 and 175.0±75.0 minutes for LSN, LRN and LPN, respectively. The mean length of hospital stays was 3.0±1.3, 2.7±0.6 and 2.7±1.5 days, respectively. Conversion to open surgery was done in 2 patients who underwent LRN and in two patients who underwent LSN due to intraoperative bleeding and intraperitoneal adhesions, respectively. We experienced postoperative complication only in one patient (2.5%) who underwent LSN. Conclusion: Advances in technology and surgical experience have led to an increase in laparoscopic kidney surgery even for advanced renal tumors. Serious complications may occur mainly in the early stages of the learning curve, but complication rates and operative time significantly decrease by the surgeons' experience. Complicated and more extensive tumors make surgeons more experienced in advanced laparoscopic treatment techniques.

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“…1 Because of the low incidence of perioperative complications and the similar oncology control effect to open surgery, laparoscopic nephroureterectomy (LNU) is preferred in the majority of medical centers. 2 Transperitoneal approach and retroperitoneal approach as two common methods in LNU, have their own advantages and disadvantages. Compared to retroperitoneal approach, it's easier to recognize anatomic landmarks during a transperitoneal approach, and it owns larger surgical space, which makes it easier to find the most appropriate angle for manipulating tissues.…”

Section: Introductionmentioning

confidence: 99%

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

Song¹,

Wang²,

Zhao³

et al. 2020

CMAR

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Background: The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes. Methods: From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results: LNU was performed successfully on all 106 patients. There was no significant difference in patients' characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P<0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P<0.001). Conclusion: The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.

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Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma

Abstract: Our results indicated that LNU is a safe and effective method to treat UTUC. Given the limitations of this study, further multicenter, randomized trials are required to confirm these findings.

Cited by 26 publications

References 45 publications

Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Laparoscopic Transperitoneal Simple, Radical and Partial Nephrectomy: A Single Center Experience

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

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