Prolonged pneumoperitoneum time is an independent risk factor for intravesical recurrence after laparoscopic radical nephroureterectomy in upper tract urothelial carcinoma.
OBJECTIVE
To evaluate the impact of pneumoperitoneum time on intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) patients who underwent laparoscopic radical nephroureterectomy (LRNU).


METHODS
We identified 129 UTUC patients who underwent LRNU at our three institutions from 2004 to 2014. We evaluated the association of IVR rate and patient clinico-pathological characteristics including operation time. By retrospectively reviewing all videotapes, we defined pneumoperitoneum time as being from the infusion of pressurized CO2 gas with a pressure of 10-12 mmHg to extirpation of the kidney.


RESULTS
During the median follow-up of 31.1 months, 61 (47.3%) had subsequent IVR after LRNU. Multivariate analysis revealed that prolonged pneumoperitoneum time (HR = 1.81, p = 0.025) and presence of lymphovascular invasion (LVI) (HR = 1.53, p = 0.006) were independent risk factors for subsequent IVR. The 3-year and 5-year IVR free survival rates were 43.7% and 21.8% in patients with a prolonged pneumoperitoneum time of ≥150 min, which were significantly lower than those in their counterparts (59.0% and 48.3%, respectively, p = 0.024). The subsequent IVR rates were 27.3% for a pneumoperitoneum time of <90 min, 35.8% for that of 90-150 min, 55.0% for that of 150-210 min, 61.1% for that of 210-270 min, and 85.7% for that of >270 min.


CONCLUSIONS
Prolongation of pneumoperitoneum time and presence of LVI might be associated with higher risk of subsequent IVR in UTUC patients who underwent LRNU.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Keisuke
K
Shigeta
Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: eiji-k@kb3.so-net.ne.jp.
Eiji
E
Kikuchi
Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
Masayuki
M
Hagiwara
Department of Urology, Isehara Kyodo Hospital, Kanagawa, Japan.
Toshiyuki
T
Ando
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Ryuichi
R
Mizuno
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Akira
A
Miyajima
Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
Ken
K
Nakagawa
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Mototsugu
M
Oya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects*; D011027:Pneumoperitoneum / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
Intravesical recurrence; Lymphovascular invasion; Pneumoperitoneum time; Upper tract urothelial carcinoma