Complete Transperitoneal Laparoscopic Radical Nephroureterectomy For Upper Tract Urothelial Carcinoma

Objectives:To evaluate the safety and advantages of complete transperitoneal laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma.Methods:Between January 2009 and December 2014,49 patients with nonmetastatic upper tract urothelial carcinoma and without a previous history of a urothelial tumor underwent radical nephroureterectomy. Of those,28 patients (group A) underwent complete transperitoneal laparoscopic radical nephroureterectomy with bladder cuff resection, and 21 patients (group B) received transperitoneal laparoscopic nephrectomy with open distal ureterectomy. In group A, bladder cuff resection was performed with a 12-mm Hem-o-lok clip.Results:The operations were successfully completed in all 49 patients. Group A benefited from less intraoperative blood loss (72.86±35.16 mL vs 120.48±71.09 mL, p=0.009), a shorter operation time (112.86±33.76 minutes vs 170.00±50.29 minutes, p<0.001), and a shorter postoperative hospital stay (11.00±2.78 vs 16.05±6.03 days, p<0.001) compared to group B. The perioperative complication rate was not significantly different between the two groups (P=0.43). No significant difference in pathologic grade or stage between the two groups. The median follow-up times of group A and group B were 24 months and 29.5 months, respectively. No significant differences in urothelial tumor-free survival (log rank test; P= 0.47), metastasis-free survival log rank test; P= 0.53), or cancer-specific survival (log rank test; P= 0.90) were found between the two groups.Conclusions:Complete transperitoneal laparoscopic radical nephroureterectomy was safe and effective compared to open distal ureterectomy. The main advantages of the former were less blood loss, shorter operation time and faster postoperative recovery. However, future long-term follow-up studies are needed to obtain valuable oncologic results.