Laparoscopic Nephroureterectomy in Patient with an Upper Urinary Tract Transitional Cell Carcinoma: Safety and Efficacy

Abstract

Purpose: To evaluate the safety and efficacy of a laparoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and ureter. Materials and Methods: All patients underwent a nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 23 and 22 underwent a laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU), respectively, between January 2002 and June 2006. After the nephrectomy had been performed, a 5-6cm modified Gibson incision was created to allow dissection of the lower ureter and bladder cuff, and extraction of the intact specimen. A retrospective analysis was performed on the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay, complications and follow-up results for both groups. Results: The LNU was superior to the ONU with regard to the mean operation time; 275 (190-390) versus 258 (180-400) (p=0.259), blood loss; 188 (130-250) versus 488ml (350-750) (p<0.05), ambulation time; 2.5 versus 3.3 days (p<0.05), interval to resume oral intake 2.1 versus 2.8 days (p<0.05), and hospital stay; 8.3 versus 11.1 days (p<0.05). Complications developed in 4 and 5 of the LNU and ONU patients, respectively, but all were resolved with conservative management. The mean follow-up duration of the LNU and ONU groups were 29 versus 14 months, respectively. Conclusions: Based on our experience, a laparoscopic nephroureterectomy is better tolerated with respect to pain, has less blood loss, shorter hospital stays, ambulation time and time to oral intake. LNU is safe for an upper tract transitional cell carcinoma, and is also an efficacious alternative to open surgery. However, a long-term follow-up will be warranted to ascertain accurate oncologic data. (Korean J Urol 2007;48:252-258)