Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Review of the Current Literature

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In 1991, laparoscopic nephroureterectomy was been introduced as a treatment option for upper tract transitional cell carcinoma. Based on personal long-term experience and the review of the current literature, we analyzed the actual results of this technique in comparison to open surgery. We reviewed the charts and followed up 23 patients who underwent laparoscopic nephroureterectomy at the Klinikum Heilbronn between December 1994 and December 2003, and 21 patients who underwent open nephroureterectomy during the same period. Demographic, perioperative, and follow-up data were compared. Additionally, we performed a MEDLINE/PUBMED search and reviewed the literature on laparoscopic and open nephroureterectomy between 1991 and 2004 (n = 1365 patients). The analysis of the literature including the Heilbronn experience revealed a slightly longer operating time (276.6 vs 220.1 min), and signifi- cantly lower blood loss (240.9 vs 462.9 ml) in the laparoscopic series. No differences of minor (12.9% vs 14.1%) or major complication rates (5.6% vs 8.3%) were observed. All nine comparative studies revealed a significant dose reduction of the morphine equivalents after laparoscopy. In all ten comparative series the hospital stay was shorter after laparoscopy, but only in six series was the difference statistically significant. The frequency of bladder recurrence (24.0% vs 24.7%), local recurrence (4.4% vs 6.3%), and distant metastases (15.5% vs 15.2%) did not differ significantly in both groups. The actual diseasefree 2-year survival rates (75.2% vs 76.2%) were similar. The 5-year survival rates averaged 81.2% in the three laparoscopic (n = 113 patients) and 61% in the ten open series (n = 681 patients). Six port site metastases were reported in 377 (1.6%) analyzed patients occurring 3-12 months following laparoscopy. Open radical nephroureterectomy still represents the gold standard for the management of upper tract transitional cell carcinoma; however, laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deterioration in the oncological outcome. In cases of advanced tumors (pT3, N+), open surgery is still recommended.