Laparoscopic distal ureterectomy and anastomosis for management of low‐risk upper urinary tract transitional cell carcinoma: preliminary results

• Published in: BJU international 2007-03, Vol.99 (3), p.623-627
• Main Authors: Rouprêt, Morgan, Harmon, Justin D., Sanderson, Kristin M., Barret, Eric, Cathelineau, Xavier, Vallancien, Guy, Rozet, François
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - methods; Biological and medical sciences; carcinoma; Carcinoma, Transitional Cell - surgery; Feasibility Studies; Follow-Up Studies; Humans; Laparoscopy; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nephrology. Urinary tract diseases; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; transitional cell; Treatment Outcome; Tumors of the urinary system; ureter; urinary tract; Urinary tract. Prostate gland; Urologic Neoplasms - surgery; Urologic Surgical Procedures - methods
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06688.x

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA OBJECTIVE To determine the surgical feasibility and early oncological outcomes of laparoscopic distal ureterectomy in patients with low‐grade upper urinary tract transitional cell carcinoma (UUT‐TCC). PATIENTS AND METHODS We retrospectively reviewed patients treated laparoscopically with conservative management for a UUT‐TCC between 2001 and 2005. We collected data on gender, age, mode of diagnosis, smoking, history of bladder cancer, complications, tumour site, size, stage, grade, hospital stay, recurrence and progression. RESULTS Data were analysed for six patients with a mean (range) age of 68.5 (54–76) years. Four patients had a diagnostic ureteroscopy with biopsy. The operative duration was 173.3 (120–240) min, the estimated blood loss was 75 (50–200) mL and the length of ureteric resection was 5.23 cm. Two patients required a psoas hitch. JJ stents were maintained for 25.8 (15–30) days. The hospital stay was 6 (5–8) days. There were minor complications in three patients after surgery. The follow‐up was 32 (17–46) months. The tumour size was 1.7 (0.8–2.6) cm. There were low‐grade tumours in four patients and pTa in five. All patients are alive and free of disease; there were no anastomotic strictures. Two patients developed a recurrence, one in the ipsilateral renal pelvis and one in the bladder. CONCLUSION Laparoscopic distal ureterectomy with direct re‐implantation is technically feasible for low‐risk UUT‐TCC (i.e. low‐grade, noninvasive), in the properly selected patient. Early oncological outcomes are promising but strict surveillance protocols must be followed.