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Laparoscopic distal ureterectomy and anastomosis for management of low‐risk upper urinary tract transitional cell carcinoma: preliminary results
Author(s) -
Rouprêt Morgan,
Harmon Justin D.,
Sanderson Kristin M.,
Barret Eric,
Cathelineau Xavier,
Vallancien Guy,
Rozet François
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06688.x
Subject(s) - medicine , transitional cell carcinoma , upper urinary tract , ureteroscopy , anastomosis , surgery , renal pelvis , urothelial carcinoma , stage (stratigraphy) , urinary system , urology , bladder cancer , ureter , cancer , paleontology , biology
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.