Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Cancer: The Washington University Experience

Shalhav, Arieh L.; Dunn, Matthew D.; Portis, Andrew J.; Elbahnasy, Abdelhamid M.; DOUGALL, ELSPETH M. M c; Clayman, Ralph V.

doi:10.1016/s0022-5347(05)67701-4

Cited by 257 publications

(137 citation statements)

References 16 publications

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“…Stones have been reported to form on almost 50% of titanium staple lines during laparoscopic assisted continent urinary diversion in animal models. 18 However, the stapled bladder cuff showed no evidence of staple erosion or encrustation on any exposed staple despite follow up as long as 8 years in a recent report on laparoscopic nephroureterectomy in over 20 patients, 19 and Grubb et al . have studied the safety of titanium staples in laparoscopic pyeloplasty with no stone formation on follow up, although stone formation is an ongoing concern.…”

Section: Discussionmentioning

confidence: 93%

Laparoscopic radical cystectomy with extracorporeal urinary diversion: Preliminary experience

et al. 2005

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Aim : We present our experience with the first eight patients who underwent laparoscopic radical cystectomy with bilateral pelvic lymphadenectomy and extracorporeal urinary diversion. Patients, operative data and the surgical techniques are presented. Methods : Between June 2003 and April 2004, seven men and one woman with organ-confined muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with urinary diversion. The age range was 41-73 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using five ports by a transperitoneal approach. An ileal conduit diversion or ileal W-neobladder was constructed through the site of specimen retrieval.Results : We performed eight radical cystectomies with ileal conduits (six cases) or orthotopic ileal W-neobladders (two cases). Conversion to open surgery was necessary in one due to technical difficulty in urethroneobladder anastomosis. Mean operating time was 560 min (range 455-680).Mean estimated blood loss was 675 mL (range 400-1050). Two of the eight patients needed blood transfusion (800 mL each). Mean days to oral intake and ambulation was 4.4 (range 2-6) and 4.1 (range 3-5), respectively. Mean hospital stay was 12.8 days (range 7-28). Mean follow up was 6.1 months (range 4-14). Histopathological examination of the specimens revealed stage T2N0M0 in five cases, T3aN0M0 in one, T3aN1M0 in one and T3bN1M0 in one. No metastases have been detected and all are alive and free of disease. Conclusion : Laparoscopic radical cystectomy is feasible, although difficult and technically demanding, and our results are promising. With more experience and improvement of the surgical technique, laparoscopic radical cystectomy with urinary diversion may become an alternative surgical method for treating the selected patients with localized muscle invasive bladder cancer.

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Section: Discussionmentioning

confidence: 93%

Laparoscopic radical cystectomy with extracorporeal urinary diversion: Preliminary experience

et al. 2005

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“…This 75% rate of bladder cancer is substantially higher than the reported literature for patients undergoing treatment for utUC (1,11,15). Other factors including longer operative time (16) and longer length of follow-up (7,17) are associated with higher rates of bladder cancer. We postulate that seeding from the upper tract may increase the rate of bladder cancer above the already significant baseline rate in these patients.…”

mentioning

confidence: 74%

Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes

et al. 2013

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Objectives: To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. Materials and Methods: After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. Results: From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years). Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66). At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%), all with initial grade 3 renal pelvis lesions, developed metastatic disease. Conclusions: Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks.

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“…Of the seven patients who had grade 4, stage T2±4 disease in the laparoscopic group, three had local retroperitoneal tumour metastases. None of the four patients with a similar grade of disease who underwent the open procedure had evidence of retroperitoneal recurrence [48]. Although these are small series, they raise doubts about whether laparoscopic surgery is necessarily advantageous for higher stage diseases.…”

Section: Laparoscopic Nephroureterectomymentioning

confidence: 85%

“…Shalhav et al [48] reported a series of 25 patients who underwent laparoscopic nephroureterectomy and who were compared with 17 undergoing open nephroureterectomy. The results indicated that laparoscopic surgery required twice the operating time of open surgery (7.7 vs 3.9 h), although the patients from the laparoscopic group had a 74% decrease in analgesia requirement (37 vs 144 mg morphine sulphate) and a 63% shorter hospital stay (3.6 vs 9.6 days).…”

Section: Laparoscopic Nephroureterectomymentioning

confidence: 99%

Laparoscopy for urological cancers

Shah

Vale

Darzi³

2001

BJU International

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Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Cancer: The Washington University Experience

Cited by 257 publications

References 16 publications

Laparoscopic radical cystectomy with extracorporeal urinary diversion: Preliminary experience

Laparoscopic radical cystectomy with extracorporeal urinary diversion: Preliminary experience

Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes

Laparoscopy for urological cancers

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