Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma.
OBJECTIVE
Open radical nephroureterectomy has been the standard treatment for upper urinary tract transitional cell carcinoma (TCC). Laparoscopic nephroureterectomy (LN) offers the advantages of a minimally invasive approach. We report our experience with both hand-assisted LN (HALN) and total LN.


METHODS
A retrospective review was performed of all patients who underwent HALN and LN for the treatment of localized upper urinary tract TCC between 2001 and 2005. Histology of the operative specimen confirmed urothelial carcinoma in all cases. Their demographic data, perioperative parameters and follow-up data were assessed.


RESULTS
There were 31 patients with a median age of 71 years (range 39-82 years). The mean operating time was 236 min (range 120-350 min) and mean blood loss was 365 ml (range 200-2000 ml). There were no conversions to open surgery. The mean length of hospitalization was 7 days (range 3-30 days). Clear oncological margins were achieved in 27 cases. The mean duration of follow-up was 28 months (range 2-55 months).


CONCLUSIONS
HALN and LN are safe and effective alternatives to open surgery for the treatment of upper urinary tract TCC. Medium-term follow-up showed favourable oncological results. A larger sample size and a longer follow-up period are required before HALN and LN can be considered standard treatments for upper urinary tract TCC.
Shiong Lee
Lui
L
Department of Urology, Singapore General Hospital, Singapore, Singapore.
Yip
Sidney K H
SK
Hong Tan
Yeh
Y
Cheng
Christopher W S
CW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000517:prevention & control / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012008:Recurrence; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000517:prevention & control / Q000601:surgery*