Laparoscopic radical nephroureterectomy: results of an international multicenter study.

Abstract

OBJECTIVE:

To report a multicenter analysis after laparoscopic radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma.

MATERIALS AND METHODS:

A total of 116 patients (72 males; mean age 68 years) underwent laparoscopic radical nephroureterectomy at five international institutions: 51 transperitoneally, 65 retroperitoneally. Location of the primary tumor was pelvicalyceal in 70 patients (60%), ureteral in 27 (23%), and multifocal in 19 (17%). In 18 patients (15%), transurethral resection was performed for concomitant bladder tumor. The median follow-up time was 25 months (range 3-93). A minimum follow-up of 1 and 2 years was available in 77 and 41 patients, respectively.

RESULTS:

Five patients (4%) were converted to open surgery. The specimen was extracted intact in all 116 patients: using an Endocatch bag in 78 patients, a Lapsac in 5, and manually in 33. Pathologic staging was pTis in 5 (4%), pTa in 41 patients (35%), pT1 in 31 (26%), pT2 in 18 (15%), pT3 in 16 (13%), and pT4 in 5 (4%). Pathological grade was grade I in 26 patients (23%), grade II in 41 (35%), grade III in 34 (29%) and grade IV in 15 (12%). Histopathology revealed a positive surgical margin in five patients (4.5%): renal hilum (one), periureteral soft tissue (two), distal edge of the ureter/ bladder cuff (two). Local recurrence was noted in two patients (1.7%). Bladder recurrence was noted in 28 patients (24%) with a mean time to recurrence of 13.9+/-11.5 months. Distant metastases occurred in 11 patients (9%): lung (5), liver (3), bones (2), adrenal (1); mean time to metastasis was 13 months. Overall, 23 patients (20%) died. One-year and 2-year cancer-specific survival was 92% and 87%, respectively. Two-year cancer-specific survival according to pathologic stage was 89% for patients with pT1 disease, 86% for pT2, 77% for pT3, and 0% for pT4 (p=0.0001). Two-year survival according to pathologic grade was 88% for grade I, 90% for grade II, 80% for grade III, and 90% for grade IV (p>0.05).

CONCLUSION:

Laparoscopic radical nephroureterectomy appears to be an effective minimally invasive treatment for select patients with upper tract transitional cell carcinoma. Although the 2-year survival data reported herein are encouraging, longer follow-up is needed before laparoscopy can be considered as a standard treatment.

• Authors: Hazem Abou El Fettouh, Jens J Rassweiler, Michael Schulze, Laurent Salomon, James Allan, Sanjay Ramakumar, Thomas Jarrett, Claude C Abbou, David A Tolley, Louis R Kavoussi, Inderbir S Gill
• Journal: European urology (Eur Urol) Vol. 42 Issue 5 Pg. 447-52 (Nov 2002) ISSN: 0302-2838 [Print] Switzerland
• PMID: 12429152 (Publication Type: Journal Article, Multicenter Study)

Topics

• Aged
• Carcinoma, Transitional Cell (pathology, surgery)
• Female
• Humans
• Laparoscopy (methods)
• Male
• Neoplasm Recurrence, Local
• Neoplasms, Multiple Primary (pathology, surgery)
• Nephrectomy
• Survival Analysis
• Treatment Outcome
• Ureter (surgery)
• Urologic Neoplasms (pathology, surgery)