Laparoscopic nephroureterectomy for upper tract transitional cell carcinoma

The standard surgical treatment of upper tract TCC remains nephroureterectomy with excision of a cuff of bladder. However, laparoscopic nephroureterectomy (LNU) has been shown to be associated with reduced perioperative morbidity, a shorter hospital stay, and a reduced requirement for transfusion than open nephroureterectomy (ONU). The objective of this article is to review experience and outcome following laparoscopic nephroureterectomy for upper tract TCC.

A literature search of PubMed (www.ncbi.nlm.nih.gov/PubMed/) was performed and articles reporting technical aspects and outcome of laparoscopic nephroureterectomy for upper tract TCC were reviewed.

The published data show that outcomes reported following LNU in terms of cancer control are comparable to ONU, at least in the short to medium term. Despite concerns about port site recurrences there were no incidences of this in the 125 patients undergoing LNU in the reviewed reports. An interesting observation was that a high percentage of the tumours are Grade 2 or 3 when TCC affects the upper tract, unlike TCC of the bladder where the majority of tumours are of low grade and stage.

Laparoscopic nephroureterectomy is a safe treatment option for patients with upper tract TCC. The shorter hospital stay and faster overall recovery is obviously of benefit to the patient, but importantly the longer-term tumour control appears to be equivalent to that following open nephroureterectomy.