Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma.

Jay D. Raman, Michael A. Palese, Casey K. Ng, Stephen A. Boorjian, Douglas S. Scherr, Joseph J. Del Pizzo, R. Ernest Sosa

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE: We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution. METHODS: Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence. RESULTS: The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191 mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery. CONCLUSION: Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Volume10
Issue number4
StatePublished - Oct 2006
Externally publishedYes

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Transitional Cell Carcinoma
Urinary Tract
Hand
Intraoperative Complications
Length of Stay
Carcinoma
Recurrence
Neoplasms
Operative Time
Hospitalization

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Raman, J. D., Palese, M. A., Ng, C. K., Boorjian, S. A., Scherr, D. S., Del Pizzo, J. J., & Sosa, R. E. (2006). Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, 10(4), 432-438.

Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. / Raman, Jay D.; Palese, Michael A.; Ng, Casey K.; Boorjian, Stephen A.; Scherr, Douglas S.; Del Pizzo, Joseph J.; Sosa, R. Ernest.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, Vol. 10, No. 4, 10.2006, p. 432-438.

Research output: Contribution to journalArticle

Raman, Jay D. ; Palese, Michael A. ; Ng, Casey K. ; Boorjian, Stephen A. ; Scherr, Douglas S. ; Del Pizzo, Joseph J. ; Sosa, R. Ernest. / Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 2006 ; Vol. 10, No. 4. pp. 432-438.
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AU - Sosa, R. Ernest

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N2 - OBJECTIVE: We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution. METHODS: Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence. RESULTS: The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191 mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery. CONCLUSION: Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach.

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