Abstract
To report our experience with laparoscopic-assisted nephroureterectomy for upper tract transitional cell carcinomas after radical cystectomy and urinary diversion. Seven patients (53-72 years-old) underwent laparoscopic-assisted nephroureterectomy 10 to 53 months after radical cystectomy for transitional cell carcinoma at our institution. Surgical technique, operative results, tumor features, and outcomes of all patients were retrospectively reviewed. Mean operative time was 305 minutes with a significant amount of time spent on the excision of the ureter from the urinary diversion. Estimate blood loss and length of hospital stay averaged 180 mL and 10.8 days, respectively. Intraoperative and postoperative complications occurred in two patients each. There was one conversion to open surgery. Pathology confirmed upper-tract transitional cell carcinoma in all cases. Metastatic disease occurred in two patients after a mean follow-up of 14.6 months. Nephrouretectomy following cystectomy is a complex procedure due to the altered anatomy and the presence of many adhesions. A laparoscopic-assisted approach can be performed safely in properly selected cases but does not yield the usual benefits seen with other laparoscopic renal procedures.
Highlights
Nephroureterectomy (NU) is the treatment of choice for high grade, invasive, or recurrent transitional cell carcinoma (TCC) of the upper urinary tract (UUT)
The objective of this study is to report our experience with laparoscopic-assisted NU for UUT TCC after radical cystectomy
The first had been submitted to laparoscopic NU before radical cystectomy for primary UUT TCC, and developed contralateral UUT recurrence in a nonfunctioning renal unit
Summary
Nephroureterectomy (NU) is the treatment of choice for high grade, invasive, or recurrent transitional cell carcinoma (TCC) of the upper urinary tract (UUT). Nephroureterectomy following cystectomy is a very complex procedure due to the need for complete ureterectomy in the presence of many adhesions and an altered anatomy. This requires extensive enterolysis and dissection in a previously operated site to allow for removal of the ureter from the urinary diversion. There is limited data on open removal and no published data on laparoscopic NU for UUT TCC following cystectomy and urinary. The objective of this study is to report our experience with laparoscopic-assisted NU for UUT TCC after radical cystectomy
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