title: Comparison of laparoscopic, hand-assisted, and open surgical nephroureterectomy.
abstract: OBJECTIVE
  The aim of this study was to compare oncologic outcomes after laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy for upper urinary tract urothelial cancer.
  
  
  METHODS
  Between April 1995 and August 2010, 189 patients underwent laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, or open nephroureterectomy for upper urinary tract urothelial cancer. Of these patients, 110 with no previous or concurrent bladder cancer or any metastatic disease were included in this study. Cancer-specific survival, recurrence-free survival, and intravesical recurrence-free survival rates were analyzed by the Kaplan-Meier method and compared with the log-rank test. The median follow-up period for the cohort was 70 months (range, 6-192 months).
  
  
  RESULTS
  The 3 groups were well matched for tumor stage, grade, and the presence of lymphovascular invasion and concomitant carcinoma in situ. The estimated 5-year cancer-specific survival rates were 81.1%, 65.6%, and 65.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .4179). The estimated 5-year recurrence-free survival rates were 33.8%, 10.0%, and 41.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .0245). The estimated 5-year intravesical recurrence-free survival rates were 64.8%, 10.0%, and 76.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P < .0001).
  
  
  CONCLUSIONS
  Although there was no significant difference in cancer-specific survival rate among the laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy groups, hand-assisted laparoscopic nephroureterectomy may be inferior to laparoscopic nephroureterectomy or open nephroureterectomy with regard to recurrence-free survival and intravesical recurrence-free survival rates.
authors: Department of Urology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan. kitamura68447@gmail.com.
authors: Hiroshi
authors: H
authors: Kitamura
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Toshihiro
authors: T
authors: Maeda
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Toshiaki
authors: T
authors: Tanaka
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Fumimasa
authors: F
authors: Fukuta
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Ko
authors: K
authors: Kobayashi
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Naotaka
authors: N
authors: Nishiyama
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Satoshi
authors: S
authors: Takahashi
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Naoya
authors: N
authors: Masumori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*