The long‐term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy

Abstract

12%). Of the TCCs in this group half were G3 and half were invasive (pT1±3). In the ONU group there were more ureteric tumours because of selection criteria and overall 16 (39%) were G3 and half were invasive. Information on nodal status was available in one LNU and two of the ONU reports. Within a mean follow-up of 32.9 months for LNU and 42.3 months for ONU, nine (21%) of the ONU group and four (16%) of the LNU group had died, with a mean survival of 15.1 and 17 months, respectively, after surgery (not signi®-cant). All of these deaths were associated with G3 pT1±3 disease. Conclusions In this series the case mix and outcomes were similar for those undergoing LNU and ONU. As laparoscopic renal surgery is associated with less postoperative morbidity it would seem reasonable to offer LNU to all patients with upper tract TCC, where appropriate and when there is no evidence of local invasion or metastasis. Because of the strong correlation between grade and stage, preliminary ureteroscopic assessment and biopsy may in¯uence the surgical approach adopted.

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].…”

“…McNeill et al reported favorable longterm outcomes after laparoscopic nephroureterectomy compared with open nephroureterectomy; however, information on nodal status was available in only 4% of cases [6]. Although the therapeutic effectiveness of lymphoadenectomy for upper urinary tract transitional cell carcinoma has been controversial, extensive lymphoadenectomy is presently recommended in high-grade or high-stage tumors, because microscopic lymph node metastasis may be cured by surgery alone or with adjuvant chemotherapy.…”

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

“…6,11 However, the procedure is technically difficult and is associated with a steep learning curve. We feel that the handassisted approach offers several advantages over the pure laparoscopic approach.…”

Novel Renal Transplant-Related Surgical Approaches in the 21st Century

“…Since Clayman et al reported in 1991 the initial case of laparoscopic nephroureterectomy (LNU), there have been reports demonstrating that LNU decreases pain and accelerates convalescence of patients (Jarrett et al, 2001). It can be done either with pure laparoscopic approach or with the help of a hand-assisted device (McNeill et al, 2000;Gill et al, 2000;Shalhav et al, 2000;Chen et al, 2001). Operative technique of a hand-assisted nephroureterectomy (HALNU; Chen et al, 2001): The patient is placed in a 60º oblique position with no change in posture during the entire procedure.…”

“…Traditionally, open simultaneous bilateral nephroureterectomy is usually done via a long midline incision extending from the xyphoid to the symphysis pubis. To perform unilateral LNU smoothly, the patient has to be positioned at 60º oblique to a full lateral flank position for better exposure and easier dissection because the surrounding organs are displaced downward by gravity (Jarrett et al, 2001;McNeill et al, 2000;Gill et al, 2000;Shalhav et al, 2000). For laparoscopic bilateral nephroureterectomy (LBNU) to be completed in one session with the above-mentioned approach, one needs to do additional position changes to perform the nephroureterectomy on the contralateral side.…”