title: Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer.
abstract: BACKGROUND
  To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center.
  
  
  METHODS
  From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU.
  
  
  RESULTS
  The patients' characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p < 0.0001), the mean estimated blood loss (47.2 ± 82.4 versus 166.9 ± 250.9 ml, p = 0.002), and the mean hospital stay (6.1 ± 3.5 versus 8.1 ± 3.3 days, p = 0.03) of the CRNU group decreased significantly compared to the traditional group. The operative time was not affected by gender. No open conversion and major complications occurred. The surgical margin of the ureter was all negative. The mean follow-up time was 13.4 months for the CRNU group and 37.5 months for the TRNU group. All follow-up patients in the CRNU group were alive without local recurrence. No cases of port site metastasis and local recurrence were observed in both groups. Bladder tumor recurrence occurred in 4 patients of the CRNU group and 21 patients of the TRNU group.
  
  
  CONCLUSIONS
  The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Kunlin
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. doczhz@aliyun.com.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. doczhz@aliyun.com.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. doczhz@aliyun.com.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Cuijian
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Gong
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Xi
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
authors.forename: Zhisong
authors.initials: Z
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. zhoulqmail@sina.com.|Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. zhoulqmail@sina.com.|National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. zhoulqmail@sina.com.
authors.forename: Liqun
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Retroperitoneal; Retroperitoneoscopic nephroureterectomy; Upper tract urothelial cancer