Laparoscopic Radical Nephroureterectomy For Upper Tract Transitional Cell Carcinoma: Oncological Outcomes At 7 Years

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 07 Aug 2008 - 2:00 PDT

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UroToday.com - In this recent article from The Journal of Urology, Dr. Andre Berger and associates reported on the long-term oncological outcomes following laparoscopic nephroureterectomy for upper tract transitional cell carcinoma.

One hundred patients underwent laparoscopic nephroureterectomies for upper tract transitional cell carcinoma between December 1997 and August 2005. 50% of patients had muscle invasive disease or more with 28% having non-invasive disease. High-grade lesions were present in 58% of patients, multifocal disease was present in 23% and lymphovascular invasion was present in 9%. Positive surgical margins occurred in 7 patients (7%). At 2, 5 and 7 years overall survival was 81%, 59% and 50%, cancer specific survival was 91%, 77% and 72%, and recurrence-free survival was 66%, 50% and 36%, respectively. Five-year cancer specific survival by stage was 80% for pTis/Ta, 70% for pT1, 68% for pT2, 60% for pT3 and 0% for pT4. On univariate analysis non-organ confined disease and lymphovascular invasion affected cancer specific survival (p = 0.01 and 0.04, respectively). On multivariate analysis, only non-organ confined disease was a significant factor (p = 0.04). Concomitant bladder tumor at diagnosis was associated with poor recurrence-free survival on univariate and multivariate analysis (p = 0.02 and 0.01, respectively).

The authors suggest that a laparoscopic nephroureterectomy for upper tract transitional cell carcinoma has similar long-term oncological outcomes and appears comparable to those of open surgery. Certainly, patient selection factors and comparison to historical results for open nephroureterectomy complicate any accurate comparison between the two surgical approaches.

Berger A, Haber GP, Kamoi K, Aron M, Desai MM, Kaouk JH, Gill IS
J Urol. 2008 Jul 15. (Epub ahead of print)
10.1016/j.juro.2008.05.042

Reported by UroToday.com Contributing Editor David P. Wood, MD

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