title: Pneumovesicum approach to en-bloc laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial cancer: midterm oncological results.
abstract: BACKGROUND
  We reported the pneumovesicum (PV) approach to lower ureter and bladder cuff excision and closure. We believe that this approach bears the closest resemblance to the laparoscopic skill set of intravesical dissection and suturing. Herein, we report the midterm oncological results of the approach's use in a series of patients with upper tract urothelial cancer.
  
  
  METHODS
  From July 2004 to May 2010, 10 patients with upper tract urothelial cancer who underwent PV-assisted laparoscopic nephroureterectomy (LNU) were reviewed. Laparoscopic ports were inserted into the bladder via a suprapubic route, and carbon dioxide PV was induced. Laparoscopic dissection of the lower ureter and excision of the bladder cuff were then performed. The bladder defect was securely closed using laparoscopic suturing, and standard LNU followed.
  
  
  RESULTS
  Nine men and one woman with a mean age of 71.6 years (47-82) underwent the procedure. Six of the patients had renal pelvic tumor, two had upper ureter tumor, one had midureter tumor, and one had synchronous renal pelvis and upper ureter tumor. In terms of final pathology, there were three, two, and five patients with T1, T2, and T3 diseases, respectively. All of the patients had grade 2 (G2) disease, except for two with grade 3 (G3) disease. Over a median follow-up of 46 months (22-67 months), four patients developed superficial bladder tumor recurrence. The bladder and systemic recurrence rates were 40% and 10%, respectively. There was no port site recurrence.
  
  
  CONCLUSIONS
  Based on our midterm follow-up information, it can be concluded that the PV approach to en-bloc bladder cuff excision and LNU for upper tract urothelial cancer provides intermediate oncological results comparable to those of other approaches to en-bloc excision of the bladder cuff.
authors.affiliation: Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. maksk@surgery.cuhk.edu.hk
authors.forename: Siu King
authors.initials: SK
authors.lastname: Mak
authors.forename: Chi-Fai
authors.initials: CF
authors.lastname: Ng
authors.forename: Eddie S Y
authors.initials: ES
authors.lastname: Chan
authors.forename: Sidney K H
authors.initials: SK
authors.lastname: Yip
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Cheng
authors.forename: Wai Sang
authors.initials: WS
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*