Abstract
Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC). Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU). Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.
Highlights
Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world
In the Advances in Urology laparoscopic era, many attempts have been made to avoid the open approach to the distal ureter, which is still commonly used
Shalhav et al [4] described the laparoscopic stapling of the distal ureter and bladder cuff and positive margins were associated with the method
Summary
Upper tract TCC accounts for 5% of all urothelial tumors [1]. It usually occurs in patients older than 60. Upper tract TCC is diagnosed more frequently at advanced stages. In almost half the patients, tumor stages at diagnosis have been described as pT2 or higher. Since LNU was first reported by the Washington University Group in 1991 [2], the benefits of this procedure regarding perioperative morbidity, cosmesis, and convalescence have been established [3,4,5]. There are 2 laparoscopic approaches: pure laparoscopic nephroureterectomy (LNU) and hand-assisted nephroureterectomy (HALNU). Some oncological issues remain unclear, mainly management of the distal ureter and the role of lymphadenectomy
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