Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan
Osamu Kamihira1, Ryohei Hattori, Akito Yamaguchi
1Department of Urology, Komaki City Hospital, Komaki, Aichi, Japan. kmi@highway.ne.jp
European Urology
|March 21, 2009
Summary
Laparoscopic nephroureterectomy (LNUx) outcomes show a 5-year survival rate of 70% and a 43% intravesical recurrence rate. Male sex and hand-assisted approach are identified as risk factors for recurrence.
Area of Science:
- Urology
- Surgical Oncology
- Oncology
Background:
- Laparoscopic nephroureterectomy (LNUx) is a common procedure globally, yet long-term outcome data are limited.
- Understanding the long-term efficacy of LNUx is crucial for patient management and treatment planning.
Purpose of the Study:
- To evaluate the clinical outcomes and long-term cancer control following LNUx in Japan.
- To identify risk factors influencing survival and intravesical recurrence after LNUx.
Main Methods:
- A retrospective multicenter analysis of 1003 patients undergoing LNUx for upper urinary tract urothelial cancer between 1995 and 2005.
- Data collected included patient profiles, operative details, survival rates, intravesical recurrence, and associated risk factors.
Main Results:
- The 5-year overall survival rate was 70%, with independent risk factors including tumor grade, stage, multifocality, lymph-node metastasis, and bladder tumor history.
- The 5-year intravesical recurrence rate was 43%, more frequent in males, multifocal tumors, and those with prior/coexistent bladder tumors or using the hand-assisted approach.
- Complication rates were 9.3% intraoperatively and 10.7% postoperatively.
Conclusions:
- This study represents the largest multicenter analysis of LNUx to date.
- Male sex and the hand-assisted approach are identified as novel risk factors for recurrence-free survival and intravesical recurrence.
- Further comparative studies between LNUx and open nephroureterectomy with risk stratification are needed to fully ascertain LNUx effectiveness.
