Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: Comparison of retroperitoneoscopic and open nephroureterectomy

Abstract

Objectives: To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC). Patients and methods:From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression. Results:The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3-72) for RNU and 27.9 months (range 3-63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227). Conclusion:Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.

Highly predictive survival nomogram after upper urinary tract urothelial carcinoma

“…4 In the current study, the 5-year cancer-specific-mortality-free rate of patients with pT1N0 to pT2N0 upper urinarytract urothelial carcinoma was between 89.7% and 89.8% versus 69.4% and 70.1% for pT3N0 to pT4N0 patients versus between 36.3% and 41.0% for patients with pN1 to pN3 stages regardless of their T stage. Interestingly, organ confinement and lymph-node metastases were not the only determinants of cancer-specific-mortality-free rates.…”

“…[1][2][3][4][5] The pathological T and N categories and pathologically defined tumor grade are powerful indicators of prognosis. [6][7][8][9][10][11] However, to date, the ability of the combined input from pathological stage, grade, and other tumor and patient characteristics has never been examined with respect to prediction of cancer-specific mortality after nephroureterectomy.…”

Surgical management for upper urinary tract transitional cell carcinoma (UUT‐TCC): a systematic review

“…Of the 400 potentially relevant publications identified and screened for retrieval, only one RCT was identified, which compared early surgical and oncological outcomes between LNU and ONU [1]. In all, 32 observational studies comparing ONU and LNU [2–24]; five comparing various techniques to deal with the lower end of the ureter [25–29], three comparing nephron‐sparing surgery (NSS) with radical NU [30–32] and one comparing radical NU with percutaneous approaches were also identified [33] (Fig. 1).…”

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

“…12 For tumors located in the renal pelvis or ureter, transurethral electric resection combined with retroperitoneal laparoscopy indeed has advantages of small damage, little blood loss, and quick postoperative recovery. [11][12] However, tumors in the middle or lower ureter may spread out easily from the ''open'' end of ureter, and induce planting and dissemination. In patients with local tumorous invasion, adhesion of pelvic cavity, or pelvic operation history, pulling the ureter may cause ureteral breakage.…”

“…The retroperitoneal approach is featured by less interference to abdomen organs and quicker recovery of intestinal function, and it is widely appreciated by urologists and patients. [10][11] Bladder tumor recurrence might happen easily after the operation of upper urinary tract tumor, with a recurrence rate of 15% to 50%. 12 For tumors located in the renal pelvis or ureter, transurethral electric resection combined with retroperitoneal laparoscopy indeed has advantages of small damage, little blood loss, and quick postoperative recovery.…”