Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract

Thomas W. Jarrett, David Y. Chan, Jeffrey A Cadeddu, Louis R. Kavoussi

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Objectives. To establish the safety and efficacy of laparoscopic and laparoscopic-assisted nephroureterectomy. Methods. Since 1993, 25 patients with a minimum of 12 months of follow-up underwent nephroureterectomy using a total laparoscopic or laparoscopic-assisted technique. Four patients had specimen morcellation for tissue removal. All patients had regular follow-up with physical examinations, interval cystoscopy, and radiographs, depending on the metastatic potential of the tumor. Retrospective chart review was performed and assessed for operative time, blood loss, tumor pathologic stage, complications, and outcome. One patient was excluded because of an open conversion due to multiple previous abdominal surgeries and failure to progress. Results. The mean operating time was 329 minutes but decreased with experience. The median hospital stay was 4 days. Tumor stage was directly related to tumor grade. Associated bladder tumors (prior history or recurrent tumors) occurred in 50% of the patients. Ipsilateral ureteral stump site recurrence occurred in 1 patient. Although no port site seeding occurred, 1 patient, whose tumor was discovered histologically after laparoscopic pyeloplasty for presumed benign disease, developed recurrence in the renal fossa and metastatic disease. Two patients developed liver metastasis. Conclusions. Total laparoscopic and laparoscopic-assisted nephroureterectomy are acceptable alternatives to open surgery in the treatment of transitional cell carcinoma of the upper urinary tract. Tumor morcellation did not appear to adversely affect patient outcome. As with open nephroureterectomy, tumor grade is the most important prognostic indicator of local, bladder, and metastatic recurrence. No port site seeding was observed in either the total laparoscopic or laparoscopic-assisted groups.

Original languageEnglish (US)
Pages (from-to)448-453
Number of pages6
JournalUrology
Volume57
Issue number3
DOIs
StatePublished - 2001

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Transitional Cell Carcinoma
Urinary Tract
Neoplasms
Therapeutics
Recurrence
Cystoscopy
Operative Time
Urinary Bladder Neoplasms
Physical Examination
Length of Stay
Urinary Bladder
Neoplasm Metastasis
Kidney
Safety
Liver

ASJC Scopus subject areas

  • Urology

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Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract. / Jarrett, Thomas W.; Chan, David Y.; Cadeddu, Jeffrey A; Kavoussi, Louis R.

In: Urology, Vol. 57, No. 3, 2001, p. 448-453.

Research output: Contribution to journalArticle

Jarrett, Thomas W. ; Chan, David Y. ; Cadeddu, Jeffrey A ; Kavoussi, Louis R. / Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract. In: Urology. 2001 ; Vol. 57, No. 3. pp. 448-453.
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