Comparative Study
Journal Article
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The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy.

BJU International 2009 January
OBJECTIVE: To compare the overall, tumour-specific, recurrence-free, and progression- free survival of patients with upper urinary tract transitional cell carcinoma (UUT-TCC) treated with laparoscopic nephroureterectomy (LNU) or standard open NU (ONU).

PATIENTS AND METHODS: Clinical, pathological and follow-up data were analysed for 43 LNUs and 59 ONUs performed at our institution from 1999 to 2006. In LNU the kidney was removed laparoscopically as in radical nephrectomy, but without transecting the ureter. The specimen was then removed intact with the entire ureter and a bladder cuff through a nonmuscle-splitting supra-inguinal incision. ONU was performed through separate intercostal and supra-inguinal incisions with the entire specimen being removed intact with a bladder cuff through the latter.

RESULTS: The mean (SD) follow-up was 41 (20) months for LNU and 41 (29) for ONU. Pathological staging was: pTa 26% vs 20%, pT1 21% vs 27%, pT2 12% vs 17%, pT3 42% vs 34% for LNU and ONU, respectively. In all, seven vs six patients had positive nodes on final histology. Recurrent tumours in the bladder were detected in 26% of patients after LNU and in 27% after ONU after the mean follow-up. There were no local recurrences after LNU but there was local recurrence in six patients after ONU. There were no port-site metastases during the follow-up. Five LNU patients and seven ONU patients developed distant or lymph node metastasis. The actuarial 5-year tumour free-survival rate was 79% in the LNU group vs 76% in the ONU group (P = 0.82). The actuarial disease-specific survival at 5-years was 85% for LNU and 80% for ONU patients (P = 0.62). The surgical approach did not influence recurrence or survival.

CONCLUSION: Oncological results of LNU and ONU are comparable. The lower morbidity of LNU offers advantages for the patient.

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