Laparoscopic nephroureterectomy for upper tract transitional cell cancer: The Washington University experience

Purpose: Laparoscopic nephroureterectomy has only recently been done to tre at patients with upper tract transitional cell carcinoma. We retrospectivel y evaluated our experience with and long-term followup of laparoscopic neph roureterectomy, compared our results to those of contemporary series of ope n nephroureterectomy and reviewed the literature. Materials and Methods: We reviewed the charts of and followed up by telepho ne 25 patients who underwent laparoscopic nephroureterectomy between May 19 91 and June 1998, and 17 who underwent open nephroureterectomy between Marc h 1990 and January 1997. Demographic, perioperative and followup data were compared. We performed a MEDLINE search and reviewed the literature on lapa roscopic nephroureterectomy for upper tract transitional cell carcinoma. Results: Laparoscopic nephroureterectomy required twice the operating time of open nephroureterectomy (7.7 versus 3.9 hours). However, patients who un derwent the laparoscopic procedure had a 74% decrease in analgesia requirem ents (37 versus 144 mg. morphine sulfate equivalent), a 63% shorter hospita l stay (3.6 versus 9.6 days) and a 72% more rapid convalescence (2.8 versus 10 weeks). Subsequent bladder transitional cell carcinoma and overall canc er specific survival were similar at a mean followup of 2 years. There was no sign of trocar site or peritoneal seeding after laparoscopic nephrourete rectomy. Conclusions: Although laparoscopic nephroureterectomy is a longer operation , it has the same efficacy and is better tolerated by patients than open ne phroureterectomy for upper tract transitional cell carcinoma. As operating time decreases due to surgeon experience and the recent development of hand assisted laparoscopy, laparoscopic nephroureterectomy may soon become the procedure of choice for the ablative management of upper tract transitional cell carcinoma.