Do transperitoneal and retroperitoneal hand-assisted laparoscopic nephroureterectomy have different effects on intravesical recurrence?

Abstract

ObjectivesSome studies have shown that in patients with upper tract urothelial carcinoma (UTUC) who have undergone hand-assisted laparoscopic nephroureterectomy (HALNU), the narrow working space and inevitable manipulation that occurs during the retroperitoneal approach (RP-HALNU) enhances tumor cell seeding in the bladder mucosa. This study was an attempt to investigate the differences in intravesical recurrence between transperitoneal HALNU (TP-HALNU) and RP-HALNU. MethodsFrom 1999 to 2011, a total of 197 patients with UTUC were enrolled. After excluding those with a previous history of bladder cancer, 170 patients were analyzed. 65 of these underwent RP-HALNU, and 105 of these underwent TP-HALNU. The median follow-up periods were 39.2 and 46.2 months. Tumor location was divided into three groups: in the renal pelvis, in the ureter, and in both the renal pelvis and ureter. ResultsThere was no significant difference in the intravesical recurrence rate in relation to the different surgical approaches (p = 0.10), but tumor location in both the renal pelvis and ureter significantly increased the risk (Hazard ratio [HR] = 3.11, p = 0.01). In addition, advanced T stage (HR = 9.63, p < 0.01) was the only significant risk factor related to death. ConclusionsIn patients with UTUC, tumor location in both the renal pelvis and ureter determined higher susceptibility to intravesical recurrence. However, different surgical approaches to HALNU were not a significant risk factor for intravesical recurrence.