Comparison between hand-assisted laparoscopic and retroperitoneoscopic nephroureterectomy for the management of upper urinary tract urothelial carcinoma: analysis of an intermediate follow-up period.

BACKGROUND

To compare the perioperative parameters, convalescence parameters, and oncologic outcomes of intermediate follow-up between hand-assisted laparoscopic nephroureterectomy (HALNU) and hand-assisted retroperitoneoscopic radical nephroureterectomy (HARNU) in treating upper urinary tract urothelial carcinoma.

METHODS

We analyzed the data from 48 patients who underwent HALNU and 25 patients who underwent hand-assisted retroperitoneoscopic nephroureterectomy in our institution between January 1999 and December 2003 for UC of the ureter, renal pelvis, or both. Clinical preoperative and perioperative data were collected retrospectively by reviewing medical records. All specimens were pathologically confirmed. The outcomes including bladder recurrence-free survival, metastasis-free survival, cancer-specific survival, and overall survival were compared between the 2 operative methods.

RESULTS

The median follow-up period in the HALNU group was 47.5 months (range, 6 to 72 mo) and 32 months in the HARNU group (range, 21 to 43 mo). Patients' demographic data showed no significant difference between the 2 groups. The operation time was similar between the HALNU group and the HARNU group (223 min vs. 252 min; P=0.11). There was statistically less blood loss in the HALNU group compared with the HARNU group (164 mL vs. 212 mL; P=0.42). The complication rates between the HALNU group and the HARNU group were similar (10.4% and 12%, respectively, P=0.84). There was no open conversion or intraoperative mortality in both groups. The 3-year bladder recurrence-free survival, cancer-specific survival, metastasis-free survival, and overall survival rate were comparable in both groups.

CONCLUSIONS

HALNU and HARNU have comparable perioperative parameters, convalescence results, and oncologic outcomes for the management of upper urinary tract urothelial carcinoma from an intermediate follow-up period.