Retroperitoneal Laparoscopic Total Nephroureterectomy with Resectoscopic Excision of Bladder Cuff for Upper Urinary Tract Transitional Cell Carcinoma:A Report of 83 Cases / 中国微创外科杂志

ABSTRACT

Objective To evaluate the outcome and the feasibility of retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff for upper urinary tract transitional cell carcinoma.Methods A total of 83 patients with upper urinary tract transitional cell carcinoma underwent retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff from March 2003 to July 2006.The bladder cuff was transurethrally resected for 1.5 cm in circumference from the ureteric orifice.Then the total nephroureterectomy was performed laparoscopically through retroperitoneal approach.Intraurethral catheter was indwelled for 7 days postoperatively.Adjuvant radiotherapy was given in 11 patients.Results The operation was successfully completed in all the 83 patients.The operation time was 115-205 min(mean,156 min),the intraoperative estimated blood loss was 50-150 ml(mean,80 ml),and the postoperative hospital stay was 7-11 d(mean,8.5 d).Follow-up examinations were conducted for 3-38 months(mean,10.8 months).Pathological findings revealed transitional cell carcinoma in 82 patients and moderate-to-severe atypical hyperplasia of the renal pelvis epithelium in 1 patient.Cystoscopic examinations within 12 months postoperatively found bladder tumors in 6 patients,5 of whom underwent transurethral resection of tumor and 1 of whom was given laparoscopic en bloc cystectomy with left cutaneous ureterostomy.Liver metastasis was found in 2 patients with tumor of renal pelvis(pT3G3 and pT2G3)3 months after operation.Local recurrence and lung metastasis was found in 2 patients with tumor in middle segment of the ureter(pT3G3 and pT3G2-3)6 months after operation.Bone metastasis was found in 1 patient with tumor in lower segment of the ureter(pT3G3)6 months after operation.There was 1 case of loss to follow-up,while in the remaining 71 cases no recurrence or metastasis was seen.Conclusions Retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff appears to be a technically feasible operation for upper urinary tract transitional cell carcinoma,which is worthy of clinical application.