Laparoscopic radical nephroureterectomy with only three trocars: Results of a prospective single centre study

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.

Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

“…Therefore, for UTUC patients treated with chemotherapy, our nomogram may assist clinicians in accurate survival prognostication, treatment decision-making, and design of future clinical trials. At present, radical nephroureterectomy also has a lot of innovation such as laparoscopic radical nephroureterectomy with only three trocars [ 22 ] and these various new techniques can be incorporated into the futural clinical nomogram.…”