title: Tumor recurrence incidence following hand-assisted laparoscopic nephroureterectomy.
abstract: OBJECTIVE
  We evaluated the incidence of tumor recurrence following hand-assisted laparoscopic nephroureterectomy (HALNU) for the treatment of upper tract urothelial carcinoma.
  
  
  METHODS
  The medical records of consecutive patients who underwent HALNU by a single surgeon (CW) between October 2001 and May 2005 were reviewed. The ureter was clipped before kidney dissection to prevent distal migration of tumor. Following liberation of the kidney, the bladder cuff and intramural ureter were excised by using a Collings knife under cystoscopic guidance.
  
  
  RESULTS
  Ten patients were identified. The primary location of disease was confined to the intrarenal collecting system. Eight high-grade (HG) and 2 low-grade (LG) tumors were removed, with pT3 (6), pT2 (1), pT1 (1), and pTa (2) disease. The patient having a LG pTa urothelial carcinoma developed pulmonary metastasis 20 months following surgery and survived an additional 26 months. Two patients, each having a HG pT3 tumor, developed a urothelial carcinoma in the bladder contralateral to the site of ureteral excision. At a mean follow-up of 41 months, there has been no evidence of tumor recurrence in the pelvis.
  
  
  CONCLUSIONS
  Our technique of HALNU does not appear to harbor an increased risk for urothelial carcinoma recurrence.
authors.affiliation: Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
authors.forename: Motoo
authors.initials: M
authors.lastname: Araki
authors.forename: Po N
authors.initials: PN
authors.lastname: Lam
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Fetzer
authors.forename: David L
authors.initials: DL
authors.lastname: Clair
authors.forename: Carson
authors.initials: C
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D003558:Cystoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology