Nephroureterectomy For Transitional Cell Carcinoma Research Articles

Modified approach of hand-assisted laparoscopic nephroureterectomy for transitional cell carcinoma of the upper urinary tract

Objectives. To report a modified approach for hand-assisted laparoscopic nephroureterectomy (HALNU). Methods. Seven patients with localized transitional cell carcinoma of the upper urinary tract underwent unilateral HALNU. Patients were placed in a 60° oblique position during the entire procedure. Via a 7-cm Gibson incision on the lesion side, the distal ureterectomy and bladder cuff excision were done by an open method without opening the bladder. Then, with the surgeon’s hand inserted into the peritoneal cavity by way of the same wound, HALNU was performed with two to three additional laparoscopic ports. The perioperative parameters were compared with those of 15 cases of conventional open nephroureterectomy. Results. Patients in the HALNU group had significantly less mean blood loss (140 versus 455 mL) and earlier resumption of oral intake (33 versus 61 hours), required fewer narcotics (38 versus 70 mg of morphine sulfate equivalent), and were discharged earlier (7.33 versus 9.1 days), with a faster convalescence to normal activity (3.7 versus 5.6 weeks; all P < 0.05). The total mean surgical time was 3.7 hours for the HALNU group. Conclusions. Our approach used the same incision to both excise the distal ureter and apply the hand-assist device. It also preserved the benefits of the minimal invasiveness of laparoscopic surgery compared with its open counterpart.

Laparoscopic Nephrectomy and Nephroureterectomy for Renal and Upper Tract Transitional Cell Cancer

The best management for renal tumors is surgical excision. The laparoscopic technique of radical or total nephrectomy for renal cell carcinoma and radical nephroureterectomy for transitional cell carcinoma is rapidly gaining momentum as an effective method of extirpative surgery. The transperitoneal and retroperitoneal approach to either of these procedures is proving to be equally effective to open surgery with respect to tumor removal, providing similar disease-free rates. Laparoscopic surgery leads to a significantly lower intraoperative blood loss, postoperative analgesic requirement, and quicker convalescence. Presently the only drawbacks to laparoscopic surgery are longer operative times and higher costs. Fortunately, these factors are slowly approaching those of open surgery because of increased experience, improved instrumentation, and modification of the surgical technique.

A CASE OF QUADRUPLE EARLY CANCER ARISING FROM THE RENAL PELVIS, STOMACH, RECTUM AND LUNG

We describe a rare case of quadruple cancer arising from the renal pelvis, stomach, rectum and lung. A 68-year-old man who was pointed out having hematuria at a medical check up underwent a left nephroureterectomy for transitional cell carcinoma of the renal pelvis (pT1N0M0) in November 1993. In April 1996, an endoscopic mucosal resection for early gastric cancer (m, ly0, v0) was performed. After discharge, a colonoscopy showed a protruding tumor of the rectum in June 1996. This tumor was resected endoscopically, but the resected margins were positive for tumor cells. Anterior resection for rectal cancer (sm, lyl, v0, pT1N0M0) was performed. In March 1997, an abnormal shadow 10mm in diameter in the lower lobe of the left lung was pointed out and a left lower lobectomy was performed by videoassisted thoracoscopic surgery (moderately differentiated adenocarcinoma, pT1N0M0). This rare case of guadruple cancer in which all tumors were found in an early stage and curatively treated is presented here.

Abdominal Port Seeding after Laparoscopic Nephroureterectomy for Transitional Cell Carcinoma

Renal pelvic transitional cell carcinoma (TCC) accounts for approximately 5%-10% of all renal tumors, and about 5% of all urothelial tumors. 1 These rarely occur before the age of 40, the peak incidence being in the sixth and seventh decade of life. About 30% of the patients who present with upper tract urothelial tumors have extension beyond the renal pelvis or parenchyma at presentation. These patients have a five-year survival rate of less than 5%-10%. However, in patients who present with tumors localized to the urothelium or kidney, the five-year survival rate following total nephroureterectomy ranges between 75% and 100%. 2 Total nephroureterectomy with excision of the bladder cuff is the gold standard for the upper tract transitional cell carcinoma. 3 This is based on many studies which have demonstrated a high incidence (30%-75%) of subsequent tumor recurrence in ureteral stump or around ipsilateral ureteral orifice in patients treated with more conservative procedures. 4,5 Further studies have demonstrated that conservative surgery is acceptable in selected groups of patients. 6,7 With the recent developments in percutaneous, endosurgical and laparoscopic techniques, the conservative approach is being used more often, however, these modalities are not without their associated complications. Laparoscopic nephroureterectomy with cystoscopic resection of ureteric orifice is a procedure which has been used in TCC of the upper urinary tract. We report a case of transitional cell carcinoma recurrence in one of the laparoscopic ports after laparoscopic nephroureterectomy for renal TCC. Case Report A 66-year-old woman presented with a history of frank hematuria. Intravenous urogram showed a filling defect in the left renal pelvis, with the mass causing partial obstruction. Computed tomography (CT) confirmed these

Pre-aortic lymphadenopathy after nephroureterectomy for transitional cell carcinoma of the renal pelvis: Unexpected histological results

A patient underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis (pT3 G3 N0 M0). After 5 years a CT scan showed a retroperitoneal lymphadenopathy, suspected of being a metastasis. Histological examination of the surgically-removed lymph node showed seminoma. Palpation of the testes was negative. Testicular ultrasonography showed three hypoechoic areas in the right testis. Orchiectomy was subsequently performed and the histological examination of the testis confirmed the presence of seminoma (pT1).

Does flexible ureteropyeloscopy promote local recurrence of transitional cell carcinoma?

Ureteropyeloscopy has gained increasing acceptance as an initial method of diagnosis, treatment, and surveillance of upper tract hematuria and radiographically demonstrated filling defects. With its more frequent use, concern for the possibility of migration of malignant cells during endoscopy secondary to increased intrarenal pressure must be addressed. We report on 13 patients, all of whom underwent ureteropyeloscopy with biopsy and treatment one to four times prior to nephroureterectomy for transitional cell carcinoma of the renal pelvis. Only one patients had vascular/lymphatic extension, and because of the tumor growth characteristics, extension was suspected prior to endoscopy. This patient had no free cells or clumps noted. There have been no local recurrences in the follow-up of 3 months to 6 years. We believe uretero pyeloscopy to be safe and effective for endoscopic diagnosis and treatment of upper tract neoplasm.

Multiple Renal Neoplasms: A Case of 3 Histologically Dissimilar Primary Tumors

A 69-year-old woman who presented with bilateral renal masses and gross hematuria was found to have 3 different primary renal neoplasms. She first underwent left partial nephrectomy for an oncocytoma and subsequently right radical nephroureterectomy for transitional cell carcinoma of the pelvis. An incidental angiomyolipoma was found in the specimen. Deoxyribonucleic acid image analysis of all 3 tumors is presented.

Prognostic Variables in Patients with Transitional Cell Carcinoma of the Renal Pelvis and Proximal Ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymalsparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.