title: Oncologic outcomes of extravesical stapling of distal ureter in laparoscopic nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the safety and oncologic efficacy of extravesical laparoscopic stapling of the distal ureter and bladder cuff during nephroureterectomy for pelvicaliceal transitional-cell carcinoma (TCC).
  
  
  METHODS
  Patients with primary pelvicaliceal TCC and no history of TCC of the bladder or ureter who underwent extravesical laparoscopic control of the bladder cuff were compared with a similar group of patients submitted to the open transvesical approach. Operative results and oncologic outcomes were compared.
  
  
  RESULTS
  Operative time, estimate blood loss, length of hospital stay, rate of positive margins, and postoperative complications were not statistically different in the two groups of patients. With an average of almost 4 years of follow-up, the laparoscopic approach to the bladder cuff was associated with an increase in the overall rate of recurrence and a shorter recurrence-free survival, although these differences were not statistically significant. Rates of local and bladder recurrence and distant metastases were similar.
  
  
  CONCLUSIONS
  Laparoscopic stapling of the bladder cuff has oncologic efficacy and outcomes similar to those of the open transvesical approach. However, the laparoscopic procedure may carry a higher risk of recurrence and a shorter recurrence-free interval than the open transvesical approach.
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Frederico R
authors.initials: FR
authors.lastname: Romero
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schaeffer
authors.forename: Michael
authors.initials: M
authors.lastname: Muntener
authors.forename: Bruce
authors.initials: B
authors.lastname: Trock
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*