A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma.
OBJECTIVE
To report the surgical outcome of retroperitoneoscopic hand-assisted laparoscopic nephroureterectomy (LNU) with bladder cuff excision for upper urinary tract transitional cell carcinoma (TCC), and to compare the outcome with that of the open procedure (ONU).


METHODS
From January 1998 to January 2003, 145 patients with upper urinary tract TCC were enrolled in the study; 87 had ONU and 58 retroperitoneoscopic hand-assisted LNU. The specimens were reviewed by experienced pathologists to confirm the pathological stage. Operative duration, intraoperative blood loss, bowel recovery, analgesic use, hospital stay and time to convalescence were compared for both groups. The Mann-Whitney U-test and Fisher's exact test were used for statistical analysis. RESULTS The mean follow-up for ONU and LNU was 35.1 and 16.0 months, the mean operative duration 230.2 and 259.1 min (P = 0.006), the mean blood loss 747.3 and 408.9 mL (P < 0.001), the mean duration of Foley catheterization 6.8 and 5.1 days (P < 0.001), and the hospital stay 12.6 and 9.3 days (P < 0.001). The bladder recurrence rate 2 years after surgery was 9.1% for ONU and 8.6% for LNU (P = 0.23); the local recurrence rate during the follow-up was 3.4% and none, respectively (P = 0.35).


CONCLUSIONS
Although LNU took longer than ONU the intraoperative bleeding and hospital stay were better than for ONU. Both procedures have statistically comparable bladder recurrence and local recurrence rates.
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan, ROC.
Thomas Y
TY
Hsueh
Yi-Hsiu
YH
Huang
Allen W
AW
Chiu
Kun-Hung
KH
Shen
Ying-Huei
YH
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*