Long-term outcome of hand-assisted laparoscopic nephroureterectomy for pathologic T3 upper urinary tract urothelial carcinoma.
OBJECTIVE
To determine the feasibility and long-term outcomes of hand-assisted laparoscopic nephroureterectomy (HALNU) compared with open nephroureterectomy (ONU) in the management of pT(3)N0 upper urinary tract urothelial carcinoma (UUT-UC).


METHODS
Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT(3)N0 UTT-UC were matched and compared with 31 patients who underwent ONU. The oncologic out-comes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival, were statistically analyzed.


RESULTS
The median follow-up period in the HALNU group was 72 months (range 33-111 months) and 115 months in the ONU group (range 24-161 months). Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 mL versus 487 mL; P = 0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancer-specific survival, and overall survival were also comparable in both groups.


CONCLUSIONS
HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT(3)N0UUT-UC.
Chung
Shiu-Dong
SD
Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.
Chen
Shyh-Chyan
SC
Wang
Shuo-Meng
SM
Chueh
Shih-Chieh
SC
Lai
Ming-Kuen
MK
Huang
Chao-Yuan
CY
Pu
Yeong-Shiau
YS
Huang
Kuo-How
KH
Yu
Hong-Jeng
HJ
D000368:Aged; D003289:Convalescence; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*