title: Intermediate follow-up of hand-assisted retroperitoneoscopic nephroureterectomy for management of upper urinary tract urothelial carcinoma: comparison with open nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the oncologic outcomes of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) for upper urinary tract urothelial carcinoma and compare them with the data from conventional open surgery.
  
  
  METHODS
  We collected the data from 25 patients who underwent HARNU at our institution from January 1999 to December 2003 for upper urinary tract urothelial carcinoma. The clinical data were collected retrospectively by reviewing the medical records. The convalescence results and oncologic outcomes were analyzed and compared with the corresponding data from 41 contemporary conventional open nephroureterectomy (ONU) procedures.
  
  
  RESULTS
  The median follow-up period in the HARNU group was 32 months (range 21 to 43) and was 62 months (range 8 to 88) in the ONU group. Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant differences between the two groups. The HARNU group required a longer operation time (252 versus 212 minutes; P = 0.02). Significantly less blood loss (212 versus 408 mL; P = 0.03) was noted in the HARNU group. The complication rates between the HARNU group and ONU group were similar (12% and 7.3%, respectively, P = 0.67). No open conversion was required in the HARNU group. The average hospital stay, days to oral intake, days to ambulation, and dose of parenteral narcotic analgesics were significantly less in the HARNU group. No significant differences were found in the 3-year bladder recurrence-free survival rate, cancer-specific survival rate, or overall survival rate between the two groups.
  
  
  CONCLUSIONS
  The results of our study have shown that HARNU, with an open method for the removal of the distal ureter and bladder cuff, is a less-invasive technique and provides comparable oncologic outcomes as ONU for upper urinary tract urothelial carcinoma.
authors.affiliation: Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chueh
authors.forename: Yeong-Shiau
authors.initials: YS
authors.lastname: Pu
authors.forename: Ming-Kuen
authors.initials: MK
authors.lastname: Lai
authors.forename: Hong-Jeng
authors.initials: HJ
authors.lastname: Yu
authors.forename: Kuo-How
authors.initials: KH
authors.lastname: Huang
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures