Surgical management for upper urinary tract transitional cell carcinoma
Bhavan Prasad Rai1, Mike Shelley, Bernadette Coles
1Department of Urology, Academic Clinical Practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, UK.
The Cochrane Database of Systematic Reviews
|April 15, 2011
Summary
Laparoscopic surgery for upper tract transitional cell carcinoma (TCC) shows better short-term results like less blood loss and faster recovery than open surgery. Oncological outcomes appear similar between the two approaches.
Area of Science:
- Urology
- Surgical Oncology
Background:
- Upper tract transitional cell carcinoma (TCC) is rare and aggressive.
- Surgical options include open radical nephroureterectomy and laparoscopic procedures.
Purpose of the Study:
- To determine the optimal surgical management for upper tract TCC.
Main Methods:
- A comprehensive literature search identified randomized controlled trials comparing surgical approaches for localized upper tract TCC.
- Studies included adult patients with localized disease, evaluating various surgical methods.
- Primary outcomes were overall and cancer-specific survival; secondary outcomes included morbidity and quality of life.
Main Results:
- One randomized controlled trial met inclusion criteria, comparing laparoscopic and open approaches.
- Laparoscopic surgery demonstrated significantly less blood loss (104 mL vs. 430 mL) and shorter hospital stays (2.3 days vs. 3.7 days).
- Oncological outcomes, including survival rates, were comparable between the laparoscopic and open groups at 44 months median follow-up for organ-confined disease.
Conclusions:
- High-quality evidence from controlled trials is lacking to definitively establish the best surgical management for upper tract TCC.
- However, a small randomized trial and observational data suggest the laparoscopic approach offers peri-operative advantages with similar oncological results compared to open surgery.
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