title: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.
abstract: BACKGROUND
  Laparoscopic nephroureterectomy (LNUx) is prevalent in Japan and throughout the world, but long-term outcome data remain limited.
  
  
  OBJECTIVE
  To understand the present state of LNUx in Japan, we conducted a multicenter analysis of clinical outcome and long-term cancer control for patients who underwent the procedure.
  
  
  METHODS
  Between January 1995 and December 2005, 1003 patients with urothelial cancer in the upper urinary tract were treated with LNUx at 51 institutions in Japan, and patient data were collected retrospectively.
  
  
  METHODS
  Patient profiles were gathered and analyzed for survival, intravesical recurrence, and risk factors influencing them.
  
  
  CONCLUSIONS
  Median operative time was 320 min. Median bleeding volume was 232 ml. Complications occurred in 93 cases (9.3%) intraoperatively and in 107 cases (10.7%) postoperatively. Overall survival rate was 70% at 5 yr. Grade 3, pT3 or pT4, multifocal tumor, lymph-node metastasis, and previous or coexistent bladder tumor were independent risk factors for overall survival. Intravesical recurrence rate was 43% at 5 yr. Intravesical recurrence occurred more frequently in males, in patients with multifocal tumors, in patients with previous or coexistent bladder tumors, and in patients who underwent the hand-assisted approach.
  
  
  CONCLUSIONS
  Our report represents the largest multicenter analysis of LNUx reported to date. Male sex and the use of the hand-assisted approach were shown for the first time to be risk factors for recurrence-free survival and intravesical recurrence. To further analyze the effectiveness of LNUx, a long-term outcome comparison with risk stratification must be made between LNUx and open nephroureterectomy.
authors.affiliation: Department of Urology, Komaki City Hospital, Komaki, Aichi, Japan. kmi@highway.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Kamihira
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Akito
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Gen
authors.initials: G
authors.lastname: Kawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawauchi
authors.forename: Jiro
authors.initials: J
authors.lastname: Uozumi
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yokoi
authors.forename: Masao
authors.initials: M
authors.lastname: Tsujihata
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hasui
authors.forename: Keiko
authors.initials: K
authors.lastname: Miyakoda
authors.forename: Harue
authors.initials: H
authors.lastname: Tada
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ono
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*