Comparison of Tumor Seeding and Recurrence Rate After Laparoscopic vs. Open Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma.

Introduction: Laparoscopic surgery for Upper Urinary Tract Urothelial Cell Carcinoma (UTUC) is still debated for its possible seeding risk and thus consequent oncological recurrences, especially for atypical ones. The aim of the study is to compare recurrence and survival after Laparoscopic vs. Open Radical Nephroureterectomy (RNU) for Upper Urinary Tract Urothelial Cancer (UTUC). Method: A retrospective evaluation of UTUC consecutive surgeries from 2008 to 2019 was conducted, including pT ≥ 2, High Grade UTUC who underwent RNU with bladder cuff excision without concomitant lymphadenectomy in three urological tertiary centers. Statistical analyses compared recurrence and cancer specific survival, based on surgical approach, while logistic multivariate analyses and Kaplan Meyer survival curve analyzed possible risk factors for recurrence and survival. Results: One hundred seven cases of RNU, 47 (43.9%) laparoscopic and 60 (56.1%) open, were included in this report. Preoperative characteristics were comparable between groups. However, tumor stage was higher in the Open arm [T3-T4 in 44 (73.3%) vs. 20 (43.4%) in Laparoscopic]. Mean follow-up was 91.6 months in laparoscopy RNU vs. 93.5 months in open RNU. Recurrence rate (RR) was comparable between groups (p = 0.594), and so was the site, although 3 (6.3%) peritoneal recurrences were found only in laparoscopic group (p = 0.057). At multivariate logistic regression, tumor stage and surgical approach were independent predictors of recurrence (p < 0.05), while only tumor stage was predictor of cancer specific death (p = 0.029). Conclusion: Surgical approach has no impact on recurrence site, overall survival, and RR. Still, according to our data peritoneal carcinomatosis was present only in laparoscopic arm, despite how it didn't reach statistical significance.

Retroperitoneal lymph node dissection (RPLD) in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma (TCC) of the upper urinary tract: impact on survival.

OBJECTIVES: To evaluate the prognostic impact of retroperitoneal lymph node dissection (RPLD) performed during nephroureterectomy on time to recurrence and survival in patients with infiltrative transitional cell carcinoma (TCC) of the upper urinary tract. METHODS: The charts of 82 patients with T2-T4 TCC of the upper tract were retrospectively reviewed. The median patient age was 67.7 yr. Seventy-nine patients underwent nephroureterectomy and three had partial nephrectomy. Forty patients (48.8%) had RPLD with removal of more than five nodes after nephroureterectomy (group 1), whereas 42 (51.2%) had nephroureterectomy only (group 2). Median follow-up was 64.7 mo. The prognostic role of RPLD, T (2 vs. 3-4), G (2 vs. 3), N (0 vs. 1-2 vs. x), age (<65 vs. >65 yr) and sex on time to recurrence and survival were evaluated. RESULTS: Median time to recurrence and overall survival were 51.2 and 52.5 mo, respectively, in group 1 and 18.5 and 21.2 mo in group 2. Univariate analysis demonstrated that RPLD and T and N status were significantly related both to time to recurrence (p=0.009, 0.008, and 0.009, respectively) and survival (p=0.000006, 0.003, and 0.003). When analyzed using the Cox proportional hazard model, RPLD and T category were the only two factors demonstrating independent significance on overall survival (p=0.004 and 0.008). CONCLUSIONS: The results indicate a possible curative role of RPLD in the treatment of patients with infiltrative TCC of the upper urinary tract. Further randomized trials are needed to confirm these results.

The use of local anesthesia with N-DO injector (Physion) for transurethral resection (TUR) of bladder tumors and bladder mapping: preliminary results and cost-effectiveness analysis.

OBJECTIVE: We evaluated feasibility of TUR of Ta-T1 TCC of the bladder or bladder mapping under local anesthesia using a Physion endoinjector to see if correct tumor staging was possible, to check patient tolerability, and to analyze cost-effectiveness. METHODS: Thirty patients with bladder tumors and 10 patients with hematuria and/or doubtful cytologies were treated in a day hospital setting. TUR or biopsies were performed after injecting lidocaine into the outer area of the lesion in the bladder at 2-3 sites under the mucosa. A single injection per biopsy site was necessary for bladder mapping. We evaluated tolerability using the VAS questionnaire. Cost analysis considered length of hospital stay, number of anesthesiological procedures, and complications. RESULTS: The stage and grade after TUR were 19 TaG1-2, 10 T1G2, and 1 papillary hyperplasia. After bladder mapping, 5 patients had CIS and 5 had inflammation. Sixty percent of patients had no or mild pain, 30% moderate pain requiring light sedation or analgesia, and 10% severe pain requiring spinal or general anesthesia. The mean hospital stay was 9h. Four of 40 patients complained of macroscopic hematuria; one was readmitted to the ward. This procedure saved 1097.07 euros per case and 36 anesthesiological procedures were avoided. CONCLUSIONS: This is a simple, safe, cost-effective technique, allowing TUR of bladder tumors and bladder mapping in 60% of patients and, with light sedation or analgesia, in 90% of patients, with a low complication rate. Tumor staging was correct in 90% of cases. The mean hospital stay was 9h.