Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control.
OBJECTIVE
We document recurrence and survival following laparoscopic radical nephroureterectomy (LNUX) for upper tract transitional cell carcinoma (TCC) using primarily 2 methods of managing the bladder cuff.


METHODS
The records of 60 patients undergoing LNUX at our institution for upper tract TCC were reviewed retrospectively. En bloc excision of the bladder cuff was primarily performed transvesically by our described cystoscopic secured detachment and ligation method (CDL) or extravesically using a laparoscopic stapling device (LS).


RESULTS
Median followup was 23 months (range 1 to 45). Recurrence developed in 27%, 7% and 12% of cases in the bladder at a median of 5 months, retroperitoneum at 8 months and distant sites at 8 months, respectively. Compared to the novel CDL technique LS resulted in a higher positive margin rate (p = 0.046). Overall survival correlated with bladder recurrence (p = 0.003), upper tract TCC stage (p = 0.01) and method of bladder cuff control when comparing CDL vs LS (p = 0.04). Freedom from recurrent upper tract disease was related to pathological stage (p = 0.015) and bladder cuff excision method (p = 0.02).


CONCLUSIONS
These data underscore the aggressive nature of high stage, high grade upper tract TCC and validate the importance of complete excision of the distal ureter and bladder cuff during LNUX. In patients without coexisting bladder tumor the CDL method, which allows formal bladder cuff excision in a secured manner akin to that of established open surgical principles, appears oncologically valid.
Matin
Surena F
SF
Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Gill
Inderbir S
IS
D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*