Clinical study of total transperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma

Abstract

Objective To verify the safety and advantages of total transperitoneal laparoscopic nephroureterectomy (ttLNU) in the treatment of upper urinary tract urothelial carcinoma (UTUC). Methods From Jun. 2013 to Jun. 2014, there were 13 UTUC patients treated with ttLNU, including 7 males and 6 females. The mean age was 70.4 ± 8.3 yrs, and BMI was 23.3±4.1. Of them, 11 cases were diagnosed with renal pelvis carcinoma, 6 in the left and 5 in the right. 2 cases were diagnosed with left ureteral carcinoma. TNM stages were T1–T3N0M0. Patients were put on lateral position and the position was not changed during the operation. A ttLNU was performed, and the specimen was removed from the middle extended inferior umbilical incision. Results The mean operative time was 188±33 (150–240) min, the intraoperative blood loss was 150.5±60.1 (50–700) ml, and the time of out–of–bed activity was between 1 and 4 d. The mean postoperative drainage time was 6.8±4.6 (3–6) d. The mean postoperative bowel function recovery time was 1.5±1.0 (2–4) d and postoperative hospital stay was 12.8±7.0 (3–27) d. The ttLNU procedures were successfully performed in all cases without conversion to open surgery. Pathological results showed urothelial carcinoma in all cases, including 8 high grade and 5 low grade. All the surgical margins were negative. The followed up was from 2 to 12 mon, and there was no tumor recurrence and metastasis found. Conclusions Total transperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma is characterized by short operative time, low blood loss, decreased trauma and quick recovery. This is a safe and effective treatment option for the treatment of upper urinary tract urothelial carcinoma. Key words: Laparoscopic surgery; Nephroureterectomy; Renal pelvic cancer; Ureteral cancer