title: Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: oncological outcomes at 7 years.
abstract: OBJECTIVE
  We present long-term oncological outcomes following laparoscopic nephroureterectomy for upper tract transitional cell carcinoma.
  
  
  METHODS
  Between December 1997 and August 2005, 100 patients underwent laparoscopic nephroureterectomy for upper tract transitional cell carcinoma at our institution. Data were obtained from a prospectively maintained database, patient charts, telephone followup and a review of the Social Security Death Index.
  
  
  RESULTS
  Median patient age at surgery was 73 years. Final pathological stage was pTis/pTa in 28% of patients, pT1 in 31%, pT2 in 13%, pT3 in 24% and pT4 in 4%. High grade lesions were present in 58% of patients, multifocal disease was present in 23% and lymphovascular invasion was present in 9%. Positive surgical margins occurred in 7 patients (7%). Median followup was 7 years (range 2 to 10). At 2, 5 and 7 years overall survival was 81%, 59% and 50%, cancer specific survival was 91%, 77% and 72%, and recurrence-free survival was 66%, 50% and 36%, respectively. Five-year cancer specific survival by stage was 80% for pTis/Ta, 70% for pT1, 68% for pT2, 60% for pT3 and 0% for pT4. On univariate analysis nonorgan confined disease and lymphovascular invasion affected cancer specific survival (p = 0.01 and 0.04, respectively). On multivariate analysis only nonorgan confined disease was a significant factor (p = 0.04). Concomitant bladder tumor at diagnosis was associated with poor recurrence-free survival on univariate and multivariate analysis (p = 0.02 and 0.01, respectively).
  
  
  CONCLUSIONS
  To our knowledge the largest long-term followup after laparoscopic nephroureterectomy for upper tract transitional cell carcinoma is presented. Long-term oncological outcomes appear comparable to those of open surgery.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Berger
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kamoi
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery*