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Chen Y, Xu C, Mou Z, Hu Y, Yang C, Hu J, Chen X, Luo J, Zou L, Jiang H. Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2024:S2588-9311(24)00104-4. [PMID: 38693018 DOI: 10.1016/j.euo.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/25/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Cryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications. METHODS We retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs). KEY FINDINGS AND LIMITATIONS At median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs. CONCLUSIONS AND CLINICAL IMPLICATIONS In comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function. PATIENT SUMMARY Our study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.
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Affiliation(s)
- Yiling Chen
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Chenyang Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Zezhong Mou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Yun Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Jinzhong Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Xinan Chen
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China.
| | - Lujia Zou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China.
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Urology, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China.
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Shimura S, Matsumoto K, Ikeda M, Moroo S, Koguchi D, Taoka Y, Hirayama T, Murakami Y, Utsunomiya T, Matsuda D, Okuno N, Irie A, Iwamura M. A multi-institutional retrospective study of open versus laparoscopic nephroureterectomy focused on the intravesical recurrence. Asia Pac J Clin Oncol 2023; 19:71-78. [PMID: 35404494 DOI: 10.1111/ajco.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/28/2021] [Accepted: 09/12/2021] [Indexed: 01/20/2023]
Abstract
AIM Intravesical recurrence (IVR) after nephroureterectomy for upper tract urothelial carcinoma (UTUC) is relatively frequent, occurring in about 30-50% of patients. The aim of this study was to investigate the differences of the prognosis and IVR between open and laparoscopic surgery and to elucidate the risk factor of IVR. PATIENTS AND METHODS We retrospectively analyzed data from 403 patients with UTUC treated with laparoscopic or open nephroureterectomy at six affiliated hospitals between 1990 and 2015. The clinicopathological factors of each group were examined using Kaplan-Meier plots, and univariate and multivariate analyses. RESULTS There was no difference in recurrence and cancer-specific mortality between open and laparoscopic surgery in univariate and multivariate analyses. There was no significant difference in IVR rate between the laparoscopic and open groups (p = .22). Among the patients with IVR, 84% of patients relapsed within 2 years. Univariate analysis of IVR showed a significant increase in patients with low-grade (p = .03, HR = 1.64) or low-stage urothelial carcinoma (pT1 or lower, p = .006, HR = 1.77) with no lymph node involvement (p = .002, HR = 10.3) or lymphovascular invasion (p = .009, HR = 1.79). Surgical modality was not an independent factor. In multivariate analysis, there was no independent predictive factor for IVR. CONCLUSIONS There was no difference in recurrence, cancer-specific mortality, and IVR between open and laparoscopic surgery. On the other hand, our results suggested that the low malignant potential tumor may be a risk factor for IVR. This finding provides insight into IVR, which may help with the development of personalized prevention and treatment strategies.
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Affiliation(s)
- Soichiro Shimura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shigenori Moroo
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Dai Koguchi
- Department of Urology, Kitasato University Medical Center, Kitamoto, Japan
| | - Yoshinori Taoka
- Department of Urology, Kitasato University Medical Center, Kitamoto, Japan
| | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Takuji Utsunomiya
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Daisuke Matsuda
- Department of Urology, Higashiyamato Hospital, Higashiyamato, Japan
| | - Norihiko Okuno
- Department of Urology, National Hospital Organization Sagamihara Hospital, Sagamihara, Japan
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
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Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians. Int J Clin Oncol 2023; 28:155-162. [PMID: 36414826 DOI: 10.1007/s10147-022-02269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to compare the incidence of postoperative complications occurring within 30 days of surgery between octogenarians and younger patients and identify preoperative risk factors for the incidence of postoperative complications. Moreover, we also compared the oncological outcomes between octogenarians and younger patients. METHODS This retrospective study included 283 patients who underwent laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma from 2002 to 2020. The patients were divided into octogenarians and younger patients (age: < 80 years), and their clinical characteristics, perioperative parameters, and postoperative complications were evaluated. The predictors of postoperative complications were evaluated using logistic regression models. Recurrence-free survival, cancer-specific survival, and overall survival were measured using the Kaplan-Meier method. RESULTS Twelve (17.1%) octogenarians and 40 (18.7%) younger patients had postoperative complications. No significant difference in the incidence of postoperative complications was observed between octogenarians and younger patients (p = 0.14). A high body mass index was a significant risk factor for complications (p = 0.03). The 5-year recurrence-free survival, cancer-specific survival, and overall survival rates for octogenarians and younger patients were 72% and 64% (p = 0.31), 76% and 63% (p = 0.63), and 43% and 63% (p = 0.06), respectively. CONCLUSION Laparoscopic radical nephroureterectomy can be performed in octogenarians with complication rates similar to those in younger patients. Similarly, the outcomes of laparoscopic radical nephroureterectomy for oncological control do not differ significantly between octogenarians and younger patients. This procedure is safe and effective for selected octogenarians.
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Liedberg F, Abrahamsson J, Bobjer J, Gudjonsson S, Löfgren A, Nyberg M, Sörenby A. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma-feasibility and complications: a single center experience. Scand J Urol 2022; 56:301-307. [PMID: 35736556 DOI: 10.1080/21681805.2022.2091018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery. OBJECTIVE To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure. METHODS The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days. RESULTS The median age was 75 [(Inter Quartile Range) IQR 70-80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4-5 complication. The median blood loss was 50 (IQR 20-100) ml and the median hospital stay was 6 (IQR 5-7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases). CONCLUSION Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications.
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Affiliation(s)
- F Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - J Abrahamsson
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - J Bobjer
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - S Gudjonsson
- Department of Urology, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Löfgren
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - M Nyberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - A Sörenby
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
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Al Salhi Y, Fuschi A, Martoccia A, Velotti G, Suraci PP, Scalzo S, Rera OA, Antonioni A, Valenzi FM, Bozzini G, Carbone A, Pastore AL. Laparoscopic radical nephroureterectomy with only three trocars: Results of a prospective single centre study. Arch Ital Urol Androl 2022; 94:7-11. [PMID: 35352517 DOI: 10.4081/aiua.2022.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Radical nephroureterectomy (RNU) with full bladder cuff excision is the gold standard for treatment of non-metastatic upper tract urothelial cancer (UTUC). We describe our technique of laparoscopic nephroureterectomy (LNU) with bladder cuff excision technique with modified port placement, reporting our long-term follow-up outcomes. METHODS Patients affected by UTUC were prospectively enrolled and undergone to LNU. Perioperative outcomes, oncological data at 6, 12, 24 and 36 months after surgery, and all the surgical complications according to Clavien-Dindo classification were evaluated in all subjects. RESULTS A total of 50 patients with UTUC underwent LNU, using this new technique without patient and port repositioning. The mean operative time was 168 minutes, estimated blood loss was 75 mL, mean length of hospital stay was 3 days. There were no intraoperative complications while four late complications occurred (two grade IIIb and two grade II according to Clavien-Dindo classification, incisional hernias and fever, respectively). Postoperative pathology was T1 in 12 patients, T2 in 17 patients, and T3 in 21 patients. Tumor grade was low in 12 patients and high in 38 patients. CONCLUSIONS In our study the described LNU technique was related to a significant reduction in terms of operative time and length of hospital stay, with a faster patients' recovery and no peri and postoperative complications. The long-term oncological outcomes were similar to data reported in literature.
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Affiliation(s)
- Yazan Al Salhi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina.
| | - Andrea Fuschi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina.
| | - Alessia Martoccia
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Gennaro Velotti
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Silvio Scalzo
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Alice Antonioni
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | | | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina.
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Kim SH, Song MK, Ku JH, Kang SH, Jeong BC, Hong B, Seo HK. A retrospective multicenter comparison of conditional cancer-specific survival between laparoscopic and open radical nephroureterectomy in locally advanced upper tract urothelial carcinoma. PLoS One 2021; 16:e0255965. [PMID: 34634058 PMCID: PMC8504730 DOI: 10.1371/journal.pone.0255965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%–30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection. Objective This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers. Methods The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups. Results During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival. Conclusion The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Mi Kyung Song
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (HKS); (BH)
| | - Ho Kyung Seo
- Department of Urology, Center for Urologic Cancer, Hospital/Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Republic of Korea
- * E-mail: (HKS); (BH)
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Björnsson O, Jónsson E, Guðmundsson EO, Marteinsson VÞ, Nikulásson SÞ, Guðjónsson S. Operative management in patients with upper tract urothelial carcinoma in Iceland: a population-based study. Scand J Urol 2021; 55:197-202. [PMID: 33913379 DOI: 10.1080/21681805.2021.1916073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Radical nephroureterectomy is the standard treatment of organ-confined upper tract urothelial carcinoma (UTUC). The objective of this study was to investigate survival and bladder recurrence rate in Icelandic patients with UTUC who underwent radical nephroureterctomy (RNU) or other procedures with curative intent. MATERIAL AND METHODS All patients who were diagnosed with UTUC in Iceland from 2003 to 2016 and treated with curative intent were included in the study. Information on patients was obtained retrospectively from patients' medical records and from the Icelandic Cause of Death Registry. RESULTS Overall 63 patients underwent a procedure for UTUC with curative intent in Iceland during the study period. The median age was 71 years and the majority were male (65%). In 50 patients (79%), the tumor was a primary UTUC. The most common procedure was RNU (78%) and eight patients (13%) underwent a kidney-sparing procedure. No patient died within 90 d of surgery. Twenty-eight patients (44%) had pathological stage T2 or higher, whereas 35 patients (56%) had pathological stage T1 or lower. The median follow-up time was 98.8 months . During the follow-up time 25 patients (40%) were diagnosed with recurrence in the bladder. Five-year cancer-specific survival (CSS) was 67%. CONCLUSIONS This population-based study shows that the oncologic outcome in Icelandic patients with UTUC is similar to what has been reported in other countries. Bladder recurrence rate is high and can hopefully be reduced by improvements in surgical and intravesical instillation treatment. Possibly more kidney-sparing surgeries could have been done during the study period; however, careful selection for those procedures is mandatory.
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Affiliation(s)
- Oddur Björnsson
- Department of Urology, Landspitali University Hospital, Reykjavik, Iceland
| | - Eiríkur Jónsson
- Department of Urology, Landspitali University Hospital, Reykjavik, Iceland
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Whiting D, Sriprasad S. Management of the Distal Ureter in Radical Laparoscopic Nephroureterectomy for Upper Tract Urothelial Carcinoma. J Laparoendosc Adv Surg Tech A 2020; 31:610-620. [PMID: 32716832 DOI: 10.1089/lap.2020.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Management of the distal ureter during laparoscopic nephroureterectomy (LNU) for upper tract urothelial carcinoma (UTUC) is controversial. The aim of this review was to determine whether this affects oncological outcomes. Methods: A literature review was conducted searching MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials in June 2019. Studies reporting outcomes of LNU in UTUC using either open, laparoscopic, or endoscopic approaches to excise the distal ureter were identified. All eligible studies underwent critical appraisal and were excluded if not of sufficient quality. Cumulative analysis of the results was performed. Results: Nine studies with a total of 383 patients (168 open, 159 laparoscopic, and 56 endoscopic excision of distal ureter) were eligible for inclusion. Study design and outcome reporting were variable between studies. Mean age of patients was comparable (67.7 years versus 65.0 years versus 66.6 years). Mean follow-up duration was comparable between open and laparoscopic groups (46.2 months versus 45.5 months) but reduced in the endoscopic group (33.4 months). The open group had a higher proportion of high grade/G3 tumors and pT2-4 tumors when compared to the laparoscopic and endoscopic groups (P < .001 and P = .002). The open group had a higher rate of intravesical recurrence and the laparoscopic group had a higher rate of distant metastases (P < .001). Conclusion: This review has identified differences in oncological outcomes between different techniques of managing the distal ureter in LNU for UTUC. However, the poor reporting of potentially confounding factors does not enable any one technique to be recommended as superior and requires further research.
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Affiliation(s)
- Danielle Whiting
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, United Kingdom
| | - Seshadri Sriprasad
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, United Kingdom
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Comparison of modified transumbilical laparoendoscopic single-site nephroureterectomy and retroperitoneal laparoscopic nephroureterectomy: initial experience. Wideochir Inne Tech Maloinwazyjne 2019; 15:199-207. [PMID: 32117505 PMCID: PMC7020711 DOI: 10.5114/wiitm.2019.87492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Owing to the development of the laparoendoscopic single-site (LESS) procedure, transumbilical LESS nephroureterectomy (LESS-NU) has become a new approach for treating upper tract urothelial carcinoma. Aim The aim of this study is to introduce a modified LESS-NU procedure with bladder cuff excision for treating upper tract urothelial carcinoma (UTUC). We compared its clinical efficacy and postoperative outcomes in terms of follow-up time with traditional retroperitoneal laparoscopic nephroureterectomy (RL-NU). Material and methods From May 2014 to May 2019, we performed nephroureterectomy on 42 patients using the retroperitoneal approach and a modified LESS approach. A retrospective analysis was conducted for the evaluation of the clinical and postoperative outcomes between the two groups. Results The study included 25 LESS-NU and 17 RL-NU patients. All the procedures were completed successfully. The LESS-NU group had a significantly shorter mean operative time than the RL-NU group (204.4 min, 236.18 min, p = 0.005). The differences in skin incision length (2.88 cm, 8.94 cm, p < 0.001) and oral analgesic dose (n = 1.12, n = 2.75, p < 0.001) between LESS-NU and RL-NU were statistically significant. Conclusions Modified LESS-NU is a feasible and safe procedure. Compared with the retroperitoneal laparoscopic approach, the single-site approach did not alter the patients' position. LESS-NU is a better procedure for treating UTUC than RL-NU in terms of cosmetic result and postoperative pain.
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Yamamoto S, Sakamoto S, Imamura Y, Sazuka T, Nakamura K, Inoue T, Chiba K, Miyazaki K, Inoue A, Nagata M, Ichikawa T. Intravesical irrigation might prevent bladder recurrence in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 2019; 26:791-796. [PMID: 31081198 DOI: 10.1111/iju.14014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To examine the effectiveness of intravesical irrigation with physiological saline solution or distilled water for the prevention of bladder recurrence in patients undergoing laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. METHODS This retrospective study involved 109 upper urinary tract urothelial carcinoma patients who underwent laparoscopic nephroureterectomy, and were evaluated at Chiba University Hospital and Yokohama Rosai Hospital between 2001 and 2018. We investigated the outcomes and analyzed various clinical factors including with or without intravesical irrigation related to bladder carcinoma recurrence after surgery. Physiological saline solution or distilled water was used for irrigation, which was carried out only during surgery. RESULTS The median follow-up period after surgery was 26.1 months. Bladder recurrence was confirmed within 2 years for 45 of the 109 patients in the present study. Irrigation was carried out for 48 cases (distilled water, 26 patients; physiological saline solution, 22 patients). Tumor grade (G1-2 vs G3; P = 0.05) and intravesical irrigation (yes vs no; P = 0.0058) were related to bladder recurrence on univariate analyses. On multivariate analyses, intravesical irrigation was the independent factor involved in the prevention of bladder recurrence (P = 0.0051). Comparison between the irrigation and non-irrigation groups showed that bladder recurrence rates were significantly lower in the irrigation group (irrigation group vs non-irrigation group: 25.0% vs 52.5%, P = 0.0066). There was no significant difference in the recurrence rate between the two solutions used for irrigation. CONCLUSIONS Intravesical irrigation during surgery of upper urinary tract urothelial carcinoma might decrease postoperative bladder recurrence rates.
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Affiliation(s)
| | | | - Yusuke Imamura
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | | | - Toshihito Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | | | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
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Lee H, Kim HJ, Lee SE, Hong SK, Byun SS. Comparison of oncological and perioperative outcomes of open, laparoscopic, and robotic nephroureterectomy approaches in patients with non-metastatic upper-tract urothelial carcinoma. PLoS One 2019; 14:e0210401. [PMID: 30620766 PMCID: PMC6324816 DOI: 10.1371/journal.pone.0210401] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To compare the oncological and perioperative outcomes of different nephroureterectomy approaches in patients with non-metastatic upper tract urothelial carcinoma (UTUC). METHODS We retrospectively analyzed the data of 422 patients who underwent open, laparoscopic, or robotic nephroureterectomy for non-metastatic UTUC. Perioperative and postoperative survival outcomes were compared using Kaplan-Meier analyses and Cox-proportional hazard models. RESULTS Of the patients, 161, 137, and 124 were treated with an open, laparoscopic, and robotic approach, respectively. Laparoscopic and robotic approaches involved significantly less blood loss (p = 0.001), shorter hospital stay (p < 0.001), and longer operation time (p < 0.001) compared with the open approach. There were no significant differences in intraoperative complications (open, 8.1%; laparoscopic, 5.1%; robotic, 7.3%; p = 0.363) or early postoperative complications (open, 14.9%; laparoscopic, 14.6%; robotic, 13.7%; p = 0.880). The laparoscopic and robotic groups showed significantly less postoperative analgesic use (p = 0.015). The robotic group showed significantly longer progression-free, cancer-specific, and overall survivals than the open approach group on univariate Kaplan-Meier analysis, but surgery type was not significantly associated with survival outcomes per multivariate Cox proportional tests (all p-values > 0.05). CONCLUSION The laparoscopic and robotic approaches yielded better perioperative outcomes, such as less intraoperative bleeding, shorter hospital stays, less analgesic usage, and non-inferior oncological outcomes, compared with the open approach. Further prospective studies are needed to compare these surgical techniques.
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Affiliation(s)
- Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Ju Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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12
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Huguet J, Rosales A, Breda A, Palou J. Atypical relapses in laparoscopic and robot-assisted surgery of urothelial carcinoma of the urinary tract and bladder. Actas Urol Esp 2018; 42:485-487. [PMID: 29903613 DOI: 10.1016/j.acuro.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- J Huguet
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Rosales
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Breda
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
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13
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Nouralizadeh A, Tabatabaei S, Basiri A, Simforoosh N, Soleimani M, Javanmard B, Ansari A, Shemshaki H. Comparison of Open Versus Laparoscopic Versus Hand-Assisted Laparoscopic Nephroureterectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:656-681. [DOI: 10.1089/lap.2017.0662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Tabatabaei
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Urology, Moddares University Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Department of Urology, Shohada University Hospital, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari
- Department of Urology, Shohada University Hospital, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Shemshaki
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Papatsoris AG, Chrisofos M, Skolarikos A, Varkarakis I, Lekas A, Dellis A, Koritsiadis S, Deliveliotis C. Upper Urinary Tract Transitional Cell Carcinoma. A 10-year Experience. TUMORI JOURNAL 2018; 94:75-8. [DOI: 10.1177/030089160809400114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To present our 10-year experience with patients surgically treated for upper urinary tract transitional cell carcinoma. Patients and methods We reviewed the medical records of 264 patients (218 males and 46 females), aged 37–93 years (mean, 69.5), treated surgically for upper tract transitional cell carcinoma during the period January 1996 to December 2005. Results During the mean follow-up of 58 months (range, 12–120), local relapse was diagnosed in 14% of the patients. The mean time to recurrence was 13 months (range, 1–102). The overall mortality was 14%, and the mean survival was 109 months. Survival was significantly influenced by the following parameters: male gender (P = 0.0151), age over 80 years (P = 0.0012), location in both the pelviocaliceal system and the ureter (P = 0.051), a two incision operation (P = 0.0075), grade III (P = 0.0314), stage T3 and T4 (P <0.0001). Conclusions Tumor stage was identified as the most important determinant in predicting recurrence and survival. Other predictors of survival included male gender, age over 80 years, location in the pelviocaliceal system and the ureter, a two incision operation, and high grade.
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Affiliation(s)
- Athanasios G Papatsoris
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Michael Chrisofos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Andreas Skolarikos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Ioannis Varkarakis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Alexandros Lekas
- Department of Urology, General Hospital of Nikea, Piraeus, Greece
| | - Athanasios Dellis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | | | - Charalambos Deliveliotis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
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15
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Hu CY, Huang CY, Huang KH, Tai HC, Lin YM, Tai TY. Do transperitoneal and retroperitoneal hand-assisted laparoscopic nephroureterectomy have different effects on intravesical recurrence? UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_14_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Reekhaye A, Sriprasad S, Madaan S. A review of the contemporary management of upper urinary tract urothelial carcinoma. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817717906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Upper tract urothelial carcinoma (UTUC) is relatively rare and accounts for approximately 5% of all urothelial carcinomas. The estimated annual incidence of UTUC in Western countries is about two new cases per 100,000 inhabitants. The management of patients with upper tract urothelial carcinomas has changed significantly over the last decade with improved diagnostic techniques and treatment options. The gold-standard treatment used to be open radical nephroureterectomy with removal of the ipsilateral bladder cuff. The use of minimally invasive techniques for the diagnosis and management of upper urinary tract urothelial carcinoma is however expanding and has led to a paradigm shift in treatment strategies of upper tract urothelial carcinomas. In this article, we review the current diagnostic modalities and various endoscopic techniques being currently used in the management of this relatively rare tumour.
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Affiliation(s)
| | | | - Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, UK
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17
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Do transperitoneal and retroperitoneal hand-assisted laparoscopic nephroureterectomy have different effects on intravesical recurrence? UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Stonier T, Simson N, Lee SM, Robertson I, Amer T, Somani BK, Rai BP, Aboumarzouk O. Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review. Arab J Urol 2017; 15:177-186. [PMID: 29071149 PMCID: PMC5651951 DOI: 10.1016/j.aju.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/26/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of comparative studies of laparoscopic nephroureterectomy (LNU), the standard management for upper urothelial tumours, and robot-assisted NU (RANU) that has emerged as a viable alternative. METHODS MEDLINE, EMBASE and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting on both LNU and RANU for upper urothelial tract tumours. RESULTS In all, 1630 patients were included, of which 838 underwent LNU and 792 RANU. Three studies reported on mean operative time and found it to be less in LNU, with two reporting this to be significant (RANU 298 vs LNU 251 min, P = 0.03; 306 vs 234 min, respectively, P < 0.001). Both studies reporting on median node count found this to be higher in the robotic groups: RANU 5.5 vs LNU 1.0 and RANU 21 vs LNU 11. Positive surgical margins (RANU 1.69% vs LNU 7.06%, P = 0.18), bladder recurrence (24.6% vs 36.89%, P = 0.09), and distant metastases (27.50% vs 17.50%, P = 0.29) were not significantly different between the two techniques. Disease-specific mortality did not differ between the two techniques (RANU 7.5% vs LNU 12.5%, P = 0.46), but postoperative mortality was reduced in RANU (0.14% vs 1.32%, P = 0.03). Overall complication rates were statistically lower in RANU, at 12.5% vs 18.8% (P < 0.001). CONCLUSIONS This review suggests these techniques are equivalent in terms of perioperative and oncological performance. Furthermore, there may be a lower overall complication rate, as well as postoperative mortality in the robotic group. Further research in the form of a randomised controlled trial is warranted.
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Affiliation(s)
| | - Nick Simson
- Princess Alexandra Hospital, Harlow, Essex, UK
| | - Su-Min Lee
- Weston General Hospital, Weston-Super-Mare, North Somerset, UK
| | | | - Tarik Amer
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Southampton, Hampshire, UK
| | - Bhavan P Rai
- James Cook University Hospital, Middlesbrough, North Yorkshire, UK
| | - Omar Aboumarzouk
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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19
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Liu JY, Dai YB, Zhou FJ, Long Z, Li YH, Xie D, Liu B, Tang J, Tan J, Yao K, He LY. Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study. BMC Surg 2017; 17:8. [PMID: 28095848 PMCID: PMC5240226 DOI: 10.1186/s12893-016-0202-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/30/2016] [Indexed: 12/18/2022] Open
Abstract
Background Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1–4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1–4/N0-X UTUC. Methods We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1–4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox’s proportional hazards model was used for univariate and multivariate analysis. Results The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46–3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54–1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616–3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81–3.17, P = 0.17). Conclusions The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1–4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.
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Affiliation(s)
- Jian-Ye Liu
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Ying-Bo Dai
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Fang-Jian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Zhi Long
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yong-Hong Li
- Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Dan Xie
- Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Bin Liu
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jin Tang
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jing Tan
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Le-Ye He
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China. .,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
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20
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Abstract
Radical nephroureterectomy (RNU) is the gold standard treatment strategy for bulky, high-grade, or muscle-invasive upper tract urothelial carcinoma (UTUC). Many patients with UTUC who require RNU are elderly, comorbid, and at risk for perioperative complications. Recognition of likelihood and extent of such complications guides preoperative counseling, decision-making process for major surgery, and perioperative care. A critical review of such data is essential, given the inevitable impact of complications on hospital duration, need for readmission, resource utilization, and costs associated with management.
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Affiliation(s)
- Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, c4830B, Hershey, PA, 17033, USA.
| | - Syed M Jafri
- Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, c4830B, Hershey, PA, 17033, USA
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21
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Raman JD, Lin YK, Shariat SF, Krabbe LM, Margulis V, Arnouk A, Lallas CD, Trabulsi EJ, Drouin SJ, Rouprêt M, Bozzini G, Colin P, Peyronnet B, Bensalah K, Bailey K, Canes D, Klatte T. Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy. BJU Int 2016; 119:268-275. [PMID: 27322735 DOI: 10.1111/bju.13556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To construct a nomogram based on preoperative variables to better predict the likelihood of complications occurring within 30 days of radical nephroureterectomy (RNU). PATIENTS AND METHODS The charts of 731 patients undergoing RNU at eight academic medical centres between 2002 and 2014 were reviewed. Preoperative clinical, demographic and comorbidity indices were collected. Complications occurring within 30 days of surgery were graded using the modified Clavien-Dindo scale. Multivariate logistic regression determined the association between preoperative variables and post-RNU complications. A nomogram was created from the reduced multivariate model with internal validation using the bootstrapping technique with 200 repetitions. RESULTS A total of 408 men and 323 women with a median age of 70 years and a body mass index of 27 kg/m2 were included. A total of 75% of the cohort was white, 18% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2, 20% had a Charlson comorbidity index (CCI) score >5 and 50% had baseline chronic kidney disease (CKD) ≥ stage III. Overall, 279 patients (38%) experienced a complication, including 61 events (22%) with Clavien grade ≥ III. A multivariate model identified five variables associated with complications, including patient age, race, ECOG performance status, CKD stage and CCI score. A preoperative nomogram incorporating these risk factors was constructed with an area under curve of 72.2%. CONCLUSIONS Using standard preoperative variables from this multi-institutional RNU experience, we constructed and validated a nomogram for predicting peri-operative complications after RNU. Such information may permit more accurate risk stratification on an individual cases basis before major surgery.
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Affiliation(s)
- Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yu-Kuan Lin
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex Arnouk
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah J Drouin
- Department of Urology, Pitie Salpétrière Hospital, AP-HP, University Paris 6, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitie Salpétrière Hospital, AP-HP, University Paris 6, Paris, France
| | - Gregory Bozzini
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Pierre Colin
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Kari Bailey
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - David Canes
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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22
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Laparoscopic nephroureterectomy for upper tract urothelial carcinoma - Update. Asian J Urol 2016; 3:115-119. [PMID: 29264177 PMCID: PMC5730822 DOI: 10.1016/j.ajur.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/08/2016] [Accepted: 05/12/2016] [Indexed: 12/13/2022] Open
Abstract
Upper urinary tract urothelial carcinomas (UTUCs) are uncommon and account for only 5%-10% of urothelial carcinomas. Pyelocaliceal tumors are about twice as common as ureteral tumors. Sixty percent of UTUCs are invasive at diagnosis. Radical nephroureterectomy, including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs, because of the high potential for recurrence, multifocality, and progression. Since first laparoscopic nephroureterectomy (LNU) was introduced by Clayman et al. in 1991 and improvement of laparoscopic technique and equipment, LNU has been reported to be equivalent to conventional open method. We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects, peri-operative and oncological outcomes. Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs. Indications tend to increase as operator skills increase. Indications for laparoscopic or open nephroureterectomy are in principle the same. The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
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23
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Yao L, Yang K, Li X, Zhang Z, Zhang C, Gong K, Xi Z, He Z, Zhou L. Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer. World J Surg Oncol 2016; 14:171. [PMID: 27349891 PMCID: PMC4924241 DOI: 10.1186/s12957-016-0924-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Lin Yao
- 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
| | - Kunlin Yang
- 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
| | - Xuesong Li
- 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
| | - Zheng Zhang
- 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.
| | - Cuijian Zhang
- 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
| | - Kan Gong
- 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
| | - Zhijun Xi
- 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
| | - Zhisong He
- 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
| | - Liqun Zhou
- 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.
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Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes. Surg Endosc 2016; 30:5537-5541. [PMID: 27129558 DOI: 10.1007/s00464-016-4922-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Radical nephroureterectomy is considered as the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Laparoscopic radical nephroureterectomy (LNU) can be performed via the transperitoneal (TLNU) or retroperitoneal (RLNU) approach, and each one has its own advantages and limitations. Our study was conducted to describe the difference between TLNU and RLNU by comparing the perioperative outcomes. METHODS From January 2009 to October 2014, 68 patients underwent TLNU or RLNU at our center were retrospectively collected and 1:1 matched for age, body mass index and tumor side. Baseline characteristics and perioperative outcomes were evaluated and compared, respectively. RESULTS There were no significant differences between the TLNU and RLNU group in terms of baseline characteristics, operating time, estimated blood loss, visual analogue pain scale, cosmetic results, intraoperative and postoperative complication rate. Compared to TLNU approach, RLNU was associated with a quicker time to first oral intake (2.9 vs 2.0 days, p = 0.02) and hospital discharge (6.7 vs 5.6 days, p = 0.02). CONCLUSION Both transperitoneal and retroperitoneal laparoscopic approaches are safe and effective methods for treatment of UTUC. Retroperitoneal approach has the advantage in terms of quicker bowel recovery and shorter hospital discharge.
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25
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The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. Urol Oncol 2016; 34:121.e15-21. [DOI: 10.1016/j.urolonc.2015.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/13/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022]
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26
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Yamashita S, Ito A, Mitsuzuka K, Tochigi T, Namima T, Soma F, Aizawa M, Ioritani N, Kaiho Y, Arai Y. Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 2016; 23:378-84. [DOI: 10.1111/iju.13054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Shinichi Yamashita
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Akihiro Ito
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Koji Mitsuzuka
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Tatsuo Tochigi
- Department of Urology; Miyagi Cancer Center; Natori Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Takashige Namima
- Department of Urology; Tohoku Rosai Hospital; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Fumihiko Soma
- Department of Urology; Hachinohe City Hospital; Hachinohe Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Masataka Aizawa
- Department of Urology; Japan Community Health Care Organization Sendai Hospital; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Naomasa Ioritani
- Department of Urology; Japan Community Health Care Organization Sendai Hospital; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Yasuhiro Kaiho
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
- Tohoku Urological Evidence-Based Medicine Study Group; Japan
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27
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Oncologic Outcomes Following Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma. J Urol 2015; 194:1561-6. [DOI: 10.1016/j.juro.2015.07.081] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2015] [Indexed: 11/17/2022]
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28
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Shan H, Wang X, Sun Q, Chen Q, Xu B, Hao Y, Xu W. Oncologic Results of Retroperitoneoscopic Versus Open Surgery for T2 Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:568-73. [DOI: 10.1016/j.clgc.2015.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 11/27/2022]
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29
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Melquist JJ, Redrow G, Delacroix S, Park A, Faria EE, Karam JA, Matin SF. Comparison of Single-docking Robotic-assisted and Traditional Laparoscopy for Retroperitoneal Lymph Node Dissection During Nephroureterectomy With Bladder Cuff Excision for Upper-tract Urothelial Carcinoma. Urology 2015; 87:216-23. [PMID: 26494291 DOI: 10.1016/j.urology.2015.07.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/07/2015] [Accepted: 07/27/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the results of traditional laparoscopy and a simple, single-docking robotic approach for retroperitoneal lymph node dissection (RPLND), nephroureterectomy, and bladder cuff excision. MATERIALS AND METHODS We evaluated 63 and 37 consecutive patients who underwent laparoscopic and robotic nephrouretectomy with RPLND, respectively, for upper-tract urothelial carcinoma (UTUC). RESULTS Our robotic approach was associated with improved lymph node procurement (21.0 nodes [interquartile range 16.0-30.0]) when compared with laparoscopy (11.0 nodes [interquartile range 5.5-21.0]) (P < .0001). Major blood loss as defined by requiring a blood transfusion was less for the robotic group than for the laparoscopic cohort (8% vs 30%) (P = .012). In contrast, the robotic group had longer operative times (5.1 vs 3.9 hours) (P = .0001) and longer hospital stays (5.0 vs 4.0 days) (P = .0002). CONCLUSION Our single-docking robotic technique for concomitant RPLND during nephrouretectomy is associated with improved lymph node yield.
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Affiliation(s)
- Jonathan J Melquist
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grant Redrow
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Delacroix
- Department of Urology, Louisiana State University, New Orleans, LA
| | - Andrew Park
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eliney E Faria
- Department of Urology, Barretos Cancer Hospital, Barretos, Brazil
| | - Jose A Karam
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Robot-Assisted Laparoscopic Nephroureterectomy versus Hand-Assisted Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: A Matched Comparison Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:918486. [PMID: 26539538 PMCID: PMC4619898 DOI: 10.1155/2015/918486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/17/2015] [Accepted: 08/02/2015] [Indexed: 12/20/2022]
Abstract
Objectives. To investigate the perioperative and oncological outcomes of hand-assisted laparoscopic nephroureterectomy (HANU) and robotic-assisted nephroureterectomy (RANU). Methods. Patients who underwent RANU were matched by sex, age (±5 years), and tumor location to those who underwent HANU; 18 matched pairs were included. Results. Each group consisted of five men and 13 women. The mean age was 70.4 years in RANU group and 69.6 years in HANU group (p = 0.646). Each group contained 10 patients with tumor location in the renal pelvis, five in the ureter, and three in both sites. The median follow-up time was 6.1 months for the RANU group and 47.8 months for the HANU group. The demographic and pathological data did not differ significantly. The RANU group had significantly less blood loss (p < 0.001), resumed oral intake earlier (p = 0.043), and had shorter hospital stays (p = 0.014) but higher pain scores associated with their wounds (p = 0.043). The oncological outcomes were comparable with those of the HANU group. Conclusions. Our results show that the RANU and HANU groups have comparable operative, early postoperative, and functional outcomes. A longer follow-up period would be needed for final comparison of oncological outcome.
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31
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Lopera Toro AR, Saldarriaga Botero JP, Gallo Ríos JF, Velásquez Ossa DA, Federico EJ. Nefroureterectomía más linfadenectomía retroperitoneal laparoscópica. Rev Urol 2015. [DOI: 10.1016/j.uroco.2015.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Liu JB, Lu ZB, Xiao XM. Laparoscopic Radical Nephrectomy of Wilms' Tumor and Renal Cancer in Children: Preliminary Experience from a Two-Center Study in China. J Laparoendosc Adv Surg Tech A 2015; 25:516-21. [PMID: 25974244 DOI: 10.1089/lap.2014.0342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jiang-Bin Liu
- Department of Pediatric Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Bao Lu
- Department of Pediatric Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xian-Min Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
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Henderson JM, Fabricius MJ, Fowler S, Keeley FX, Dickinson A. The complications of laparoscopic renal surgery: A review of 10 years of audit data in the UK. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815585211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To report the complications of laparoscopic renal surgery from the British Association of Urological Surgeons (BAUS) database over ten years. Patients and methods: All entries for laparoscopic renal surgery between 2002 and 2012 were included for analysis. Data was refined, collated and presented in graphical or tabular form. The primary outcome measures were intra-operative, post-operative and overall complications rates. Secondary outcome measures were length of stay, conversion to open surgery and operative time. Results: A total of 16,869 cases were included for analysis. The overall complication rate was 14.7%, with intra-operative complications reported for 3.5% of procedures and post-operative complications reported for 12.1% of procedures. The overall complication rate decreased throughout the audit period, from 16.6% in 2002 to 15.1% in 2012. The capture rate is estimated at 30% and the group of surgeons motivated to self-report may not be representative of the whole group. Comparison with other series is difficult due to a lack of a standardized reporting format. Conclusion: This is the largest surgeon-reported series of laparoscopic renal surgery to date. There is an inherent bias in self-reported data which limits the conclusions that can be drawn, although the safe introduction of this technique and the continuing improvement in complication rates are suggested.
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Lucca I, Leow JJ, Shariat SF, Chang SL. Diagnosis and Management of Upper Tract Urothelial Carcinoma. Hematol Oncol Clin North Am 2015; 29:271-88, ix. [DOI: 10.1016/j.hoc.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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35
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Guo G, Yang Y, Dong J, Zhenhong Z, Zhang X. A New 2-Micrometer Continuous Wave Laser Method for Management of the Distal Ureter in Retroperitoneal Laparoscopic Nephroureterectomy. J Endourol 2015; 29:430-4. [PMID: 25558002 DOI: 10.1089/end.2014.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gang Guo
- Department of Urology, PLA General Hospital, Beijing, China
| | - Yong Yang
- Department of Urology, PLA General Hospital, Beijing, China
| | - Jun Dong
- Department of Urology, PLA General Hospital, Beijing, China
| | - Zhou Zhenhong
- Department of Pathology, PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, PLA General Hospital, Beijing, China
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36
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A contemporary review of management and prognostic factors of upper tract urothelial carcinoma. Cancer Treat Rev 2015; 41:310-9. [DOI: 10.1016/j.ctrv.2015.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 01/02/2023]
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37
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Molina R, Alvarez M, Capilla J, Páez A. Radiofrequency-treated recurrence of urothelial carcinoma of the upper urinary tract after nephroureterectomy. Korean J Urol 2014; 55:844-6. [PMID: 25512821 PMCID: PMC4265721 DOI: 10.4111/kju.2014.55.12.844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022] Open
Abstract
Local recurrence after radical nephroureterectomy (RNU) owing to urothelial carcinoma of the upper urinary tract is rare. The usual treatment is systemic chemotherapy followed by optional resection of the mass. We introduce the case of a 73-year-old male patient with multiple comorbidities in whom retroperitoneal carcinoma recurrence of 31 mm was diagnosed via positron emission tomography-computed tomography scan with 18-fluorodeoxyglucose about 5 years after he had undergone RNU owing to urothelial carcinoma of the upper urinary tract. The patient was treated with computed tomography-guided percutaneous radiofrequency ablation. Later scans with contrast controls showed lack of contrast uptake and a decrease of the lesion's size. Twenty-four months after the procedure, the patient is free of the disease. To date, this is the first case of recurrence of urothelial carcinoma that was treated with percutaneous radiofrequency ablation, thus establishing an alternative to chemotherapy in patients with substantial comorbidities.
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Affiliation(s)
- Roberto Molina
- Department of Urology, Fuenlabrada Universitary Hospital, Madrid, Spain
| | - Manuel Alvarez
- Department of Urology, Fuenlabrada Universitary Hospital, Madrid, Spain
| | - Jesús Capilla
- Department of Radiology, Fuenlabrada Universitary Hospital, Madrid, Spain
| | - Alvaro Páez
- Department of Urology, Fuenlabrada Universitary Hospital, Madrid, Spain
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Neuzillet Y, Colin P, Phé V, Shariat S, Rouprêt M. Traitement chirurgical des tumeurs de la voie excrétrice supérieure par néphro-urétérectomie totale : état-de-l’art pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1021-9. [DOI: 10.1016/j.purol.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 06/27/2014] [Accepted: 07/16/2014] [Indexed: 01/18/2023]
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Oya M, Kikuchi E. Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition). Int J Urol 2014; 22:3-13. [PMID: 25243652 DOI: 10.1111/iju.12630] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/24/2023]
Abstract
Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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40
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Blackmur JP, Stewart GD, Egong EA, Cutress ML, Tolley DA, Riddick AC, McNeill SA. Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma. Urol Int 2014; 94:156-62. [DOI: 10.1159/000364833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022]
Abstract
Objective: Laparoscopic nephroureterectomy (LNU) offers a superior morbidity profile compared with open nephroureterectomy (ONU) in treating upper urinary tract urothelial cell carcinoma. Evidence of oncological equivalence between LNU and ONU is limited. We compare operative and oncological outcomes for LNU and ONU using matched-pair analysis. Methods: Of 159 patients who underwent a nephroureterectomy at a single institution between April 1992 and April 2010, 13 pairs of ONU and LNU patients were matched for gender, age, tumour location, tumour grade and stage. Operative details, post-operative characteristics and recurrences were collated and survival rates analysed using the Kaplan-Meier method. Results: There was no significant difference in mean operation time between LNU (191 min) and ONU (194 min, p = 0.92). There was no significant difference in the 5-year survival rate between LNU and ONU (overall survival 59.1% vs. 73.5%, p = 0.18; progression-free survival 24.0% vs. 56.0%, p = 0.14; cancer-specific survival 60.9% vs. 73.5%, p = 0.56; bladder cancer recurrence-free survival 8.7% vs. 0.0%, p = 0.09). Conclusion: Amidst limited RCT and comparative studies, this study presents further evidence of oncological equivalence between LNU and ONU. There was a trend towards poorer outcomes following LNU though, which merits further study.
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41
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Bragayrac LAN, Machuca V, Saenz E, Cabrera M, de Andrade R, Sotelo RJ. Transvesical Laparoendoscopic Single-Site Management of Distal Ureter During Laparoscopic Radical Nephroureterectomy. J Endourol 2014; 35:745-748. [PMID: 25211699 DOI: 10.1089/end.2014.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To describe the management of the distal ureter during radical nephroureterectomy with the transvesical laparoendoscopic single-site surgery (T-LESS) approach. Methods: Between January 2010 and October 2013, five patients underwent laparoscopic radical nephroureterectomy for upper urinary tract carcinoma (UTUC) with the T-LESS approach. Patients were placed in the supine position. A 2.5-cm skin incision was made in the line between the pubis and the umbilicus. The bladder was identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position; pneumovesicum was established and the ureteral openings were identified. We marked the bladder cuff with electrocautery all the way through to the extravesical fat. The bladder defect was sealed with sutures. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point, we continued with nephrectomy by standard laparoscopy or LESS. A 18F Foley catheter was placed into the bladder. Results: The mean age was 70 years (range 58-81 years), the mean operative time was 198 minutes (range 115-390 minutes), the mean time for the management of the distal ureter was 35 minutes (range 27-45 minutes), the mean estimated blood loss was 234 mL (range 60-850 mL), and the mean hospital stay was 3.8 days (range 2-8 days). In all patients the bladder cuff was free of disease. Conclusion: The transvesical laparoendoscopic single-site approach to the distal ureter for UTUC appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.
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Affiliation(s)
| | - Victor Machuca
- Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta, Caracas, Venezuela
| | - Eric Saenz
- Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta, Caracas, Venezuela
| | - Marino Cabrera
- Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta, Caracas, Venezuela
| | - Robert de Andrade
- Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta, Caracas, Venezuela
| | - Rene J Sotelo
- Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta, Caracas, Venezuela
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Varlet F, Petit T, Leclair MD, Lardy H, Geiss S, Becmeur F, Ravasse P, Rod J, de Lambert G, Braik K, Lardellier-Reynaud F, Lopez M. Laparoscopic treatment of renal cancer in children: a multicentric study and review of oncologic and surgical complications. J Pediatr Urol 2014; 10:500-5. [PMID: 24332932 DOI: 10.1016/j.jpurol.2013.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to report a multicentric study with a longer follow-up to evaluate the laparoscopic radical nephrectomy in children with renal cancer. MATERIAL AND METHODS This was a retrospective multicentric study, from October 2005 to January 2012, of children who underwent a laparoscopic radical nephrectomy for small renal malignant tumors. RESULTS Seventeen children were included in this study. Sixteen underwent chemotherapy before surgery according the SIOP (Société Internationale d'Oncologie Pédiatrique) protocol and one was treated by surgery only for a carcinoma. All except one could be treated by laparoscopy; the biggest tumoral size was 8 cm. The median hospital stay was 3 days (2-10). The pathologic examination showed 15 Wilms' tumors, one clear cell sarcoma and one TFE3 renal cell carcinoma. With a median follow-up of 42 months (range 12 and 77 months) after laparoscopic radical nephrectomy, 15 children had no oncological complications (port site or local recurrence, pulmonary metastasis) and one had a local recurrence without intraoperative tumoral rupture. The child with TFE3 renal cell carcinoma died 4 years after surgery from brain and lung metastases without local recurrence. No small bowel obstruction occurred. CONCLUSIONS Radical nephrectomy in children for Wilms' tumor or other renal cancer can be safely performed laparoscopically and our indications can be summarized, for trained laparoscopic surgeons, by small tumors under about 8 cm diameter, especially without crossing the lateral edge of the vertebra on the CT scan at the time of surgery.
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Affiliation(s)
- François Varlet
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Etienne, France.
| | - Thierry Petit
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Marc-David Leclair
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Mere enfant, Nantes, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | - Stephan Geiss
- Department of Pediatric Surgery, Centre Hospitalier, Centre de la mere et de l'enfant Le Parc, Colmar, France
| | - François Becmeur
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Hautepierre, Strasbourg, France
| | - Philippe Ravasse
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Julien Rod
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Guénolée de Lambert
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | - Karim Braik
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | | | - Manuel Lopez
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Etienne, France
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Khemees TA, Nasser SM, Abaza R. Clinical pathway after robotic nephroureterectomy: omission of pelvic drain with next-day catheter removal and discharge. Urology 2014; 83:818-23. [PMID: 24529589 DOI: 10.1016/j.urology.2013.10.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 10/14/2013] [Accepted: 10/26/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the feasibility of applying a postoperative clinical pathway after robotic nephroureterectomy (RNU) targeting safe omission of a pelvic drain and removal of the bladder catheter on the day after surgery with hospital discharge on postoperative day 1 (POD#1). METHODS We reviewed a prospectively collected database of all RNUs performed by a single surgeon (R.A.) since institution of our clinical pathway in 2008 that includes pelvic drain omission, bladder catheter removal the morning after surgery, and discharge on POD#1. Patient demographics, and perioperative and postoperative outcomes were evaluated. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined. RESULTS RNU was performed in 29 patients with mean age and body mass index of 69 years (50-90 years) and 30 kg/m(2) (19-41 kg/m(2)), respectively. No patient required a pelvic drain, and 2 were discharged with a catheter. All but 2 patients (93%) were discharged on POD#1. Overall, successful pathway application was achieved in 26 of 29 patients (90%) including no drain, catheter removal on the morning after surgery, and discharge on POD#1. No patient developed urine leak or other complications related to early catheter removal. CONCLUSION Our clinical pathway after RNU allows safe omission of a pelvic drain with early discontinuation of the bladder catheter and discharge on the POD#1 in most patients. To our knowledge, similar pathways have not been previously achieved with nephroureterectomy by any approach, but should be considered by surgeons treating urothelial carcinoma of the upper urinary tract.
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Affiliation(s)
- Tariq A Khemees
- Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH.
| | - Samiha M Nasser
- Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Ronney Abaza
- Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
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Tibi B, Quintens H, Carpentier X, Albano L, Durand M, Amiel J. Évaluation des différentes techniques d’excision de la collerette vésicale lors des néphro-urétérectomies laparoscopiques pour la prise en charge des carcinomes urothéliaux de la voie excrétrice supérieure. Prog Urol 2014; 24:94-101. [DOI: 10.1016/j.purol.2013.08.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/03/2013] [Accepted: 08/26/2013] [Indexed: 11/27/2022]
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Sun M, Abdo A, Abdollah F, Schmitges J, Thuret R, Jeldres C, Shariat SF, Perrotte P, Karakiewicz PI. Management of upper urinary tract urothelial carcinoma. Expert Rev Anticancer Ther 2014; 10:1955-65. [DOI: 10.1586/era.10.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Raman JD, Lin YK, Kaag M, Atkinson T, Crispen P, Wille M, Smith N, Hockenberry M, Guzzo T, Peyronnet B, Bensalah K, Simhan J, Kutikov A, Cha E, Herman M, Scherr D, Shariat SF, Boorjian SA. High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy. Urol Oncol 2014; 32:47.e9-14. [DOI: 10.1016/j.urolonc.2013.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Ambani SN, Weizer AZ, Wolf JS, He C, Miller DC, Montgomery JS. Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience. Urology 2013; 83:345-9. [PMID: 24315310 DOI: 10.1016/j.urology.2013.07.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/05/2013] [Accepted: 07/16/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare our initial robotic-assisted nephroureterectomy (RAN) experience with a well-established practice of performing laparoscopic nephroureterectomy (LN) to treat upper tract urothelial carcinoma (UTUC). METHODS We reviewed our prospectively maintained minimally invasive surgery database. Patients who underwent RAN from April 2009 to December 2011 were matched by pathologic tumor stage and age (± 10 years) to those who underwent LN. RESULTS Twenty-two matched pairs were evaluated. Mean operative time (298 vs 251 minutes) and estimated blood loss (EBL, 380 vs 233 mL) were significantly higher for RAN, with a greater need for transfusion in this group. Complication rates were similar. The RAN group trended toward more frequent lymph node dissection and greater median node count when lymph node dissection was performed (59% vs 27% [P = .07] and 5.5 vs 1.0 [P = .13]). After a median follow-up of 10 months for RAN and 15 months for LN, no significant difference was seen in the rate of bladder (36% vs 37%) or distant (32% vs 23%) recurrence, with similar median time to any recurrence (9 months vs 4 months, P = .32). CONCLUSION RAN was associated with higher operative time and blood loss likely because of more frequent use of node dissection, robot repositioning, and technical inexperience. Lymph node dissection was more frequently performed with RAN, which reflects surgeon practice patterns. When a lymph node dissection was performed, the median node count was greater with RAN. Our initial experience with RAN suggests that this is an acceptable approach for the management of UTUC.
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Affiliation(s)
- Sapan N Ambani
- Department of Urology, University of Michigan Health System, Ann Arbor, MI.
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Chang He
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
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Wojtarowicz M, Słojewski M, Gołąb A, Petrasz P. Retroperitoneoscopic renal pelvis resection as treatment of the urothelial tumor in a solitary kidney. Cent European J Urol 2013; 66:299-302. [PMID: 24707368 PMCID: PMC3974472 DOI: 10.5173/ceju.2013.03.art12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 04/28/2013] [Accepted: 05/16/2013] [Indexed: 12/11/2022] Open
Abstract
Urothelial carcinoma of the upper urinary tract is relatively rare. The standard treatment is invariably radical nephroureterectomy. In selected cases organ sparing surgery is justified. We present the case of the tumor of the kidney pelvis in a solitary organ where laparoscopic approach was successfully applied.
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Affiliation(s)
- Mateusz Wojtarowicz
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Petrasz
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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Borley J, Yazbek J, Farthing A. Supporting the wider use of laparoscopy in the treatment of ovarian masses. J OBSTET GYNAECOL 2013; 33:434-7. [PMID: 23815190 DOI: 10.3109/01443615.2013.783004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with ovarian masses which have a moderate risk of malignancy are frequently treated by open laparotomy, despite the Royal College of Obstetricians and Gynaecologists (RCOG) guidance indicating that laparoscopic oophorectomy may be performed in selected cases. The reluctance to perform laparoscopic surgery in these cases is normally due to the perception that survival is affected if the mass is subsequently diagnosed as being malignant, the risk of rupture impacting on FIGO stage and the need for additional staging surgery. However, there is no good evidence to support these views. Preoperative diagnosis of ovarian masses is limited and thus a significant number of patients are subjected to open surgery, where they may have benefitted from the advantages of laparoscopic surgery. We argue that in the absence of a definitive preoperative test, there are advantages to the laparoscopic approach in patients who have a moderate risk of malignancy and further high level evidence should be encouraged in this field.
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Affiliation(s)
- J Borley
- Imperial College NHS Trust, London, UK
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Pang K, Liu SB, Wei HB, Zhuo J, Li ML, Xia SJ, Sun XW. Two-micron thulium laser resection of the distal ureter and bladder cuff during nephroureterectomy for upper urinary tract urothelial carcinoma. Lasers Med Sci 2013; 29:621-7. [DOI: 10.1007/s10103-013-1365-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 06/04/2013] [Indexed: 12/01/2022]
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