Oncological control following laparoscopic nephroureterectomy: 7-year outcome.
OBJECTIVE
Proof of the oncological safety of laparoscopic nephroureterectomy (LNU) relies on truly long-term outcome being at least equivalent to that of open surgery. We compared the long-term oncological outcome of laparoscopic versus open nephroureterectomy (ONU) in patients with upper tract transitional cell carcinoma (TCC).


METHODS
Between April 1992 and January 1999, 26 LNUs and 42 ONUs were performed at our hospital for suspected upper tract TCC. Hospital medical records were retrospectively reviewed to assess preoperative staging, pathology and followup.


RESULTS
There were 4 patients excluded from study (1 who underwent LNU and 3 ONU) since the histological diagnosis was other than TCC. Median followup for the laparoscopic and open groups was 101 and 96 months, respectively. There was local recurrence in 2 patients (8%) after LNU and in 6 patients (15.4%, p = 0.3) after ONU. TCC recurred in the contralateral kidney or ureter in 2 LNU cases (8%) and 1 ONU case (2.6%, p = 0.3). There was bladder recurrence in 7 patients (28%) following LNU compared with 15 patients (42%, p = 0.2) after open nephroureterectomy. The 1 and 5-year metastasis-free survival rates were 80% and 72% for LNU compared with 87.2% and 82.1% for ONU (p = 0.33 and 0.26). Upper tract tumor grade and stage influenced the incidence of metastatic and contralateral disease, but not the incidence of local or bladder recurrence.


CONCLUSIONS
In the surgical management of upper tract TCC, the laparoscopic approach does not affect long-term oncological control. Tumor stage and grade are important prognostic factors in the development of metastases and cancer specific mortality.
Bariol
Simon V
SV
Scottish Lithotriptor Centre and Department of Urology, Western General Hospital, Edinburgh, United Kingdom.
Stewart
Grant D
GD
McNeill
S Alan
SA
Tolley
David A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000601:surgery*