Laparoscopic Nephrouterectomy for Upper Urinary Tract Transitional Cell Carcinoma. Is it a standard of care?
K. Szkarłat, P. Jarecki, T. Wandzilak, A. Nieradka
Department of Urology and Oncologic Urology Szpital Specjalistyczny w Kościerzynie
Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial carcinomas. 605 of these tumors are invasive at the time of diagnosis. In these instances open radical nephroureterectomy (ORN) with excision of the distal ureter and bladder cuff is considered the current standard of care. However, ORN has been associated with significant morbidity. In 1991, Clayman et al first described the technique of laparoscopic nephroureterectomy (LRN), and since then it has emerged as an accepted minimally invasive treatment alternative to ORN.
With the careful review of the literature and with our own experience, we analyze if LNR can be the “gold standard” of the treatment of UTUC.
Between 2000 and 2012 we performed 52 nephroureterectomies. 31 (60%) with the minimally invasive surgery technique (LNU). We discuss different techniques of management of distal ureter cuff. With the review of the literature we compared oncologic effectiveness of these procedures.
LNU in organ confined disease offers comparable oncologic efficacy and reliable perioperative safety to ONR
Well-designed randomized clinical trials with extensive follow-up are needed to confirm if it is also safe and reliable in more advanced stages.