ENDOUROLOGY & LAPAROSCOPY

Incidence of local recurrence and port site metastasis after laparoscopic radical nephroureterectomy
Muntener M, Schaeffer EM, Romero FR, Nielsen ME, Allaf ME, Brito FA, Pavlovich CP, Kavoussi LR, Jarrett TW
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Urology. 2007; 70: 864-8

• Objectives: To address the incidence of local recurrence and port site metastasis in patients who underwent laparoscopic radical nephroureterectomy (RNU) for upper tract transitional cell carcinoma (TCC).
• Methods: Between August 1993 and February 2006 116 laparoscopic RNU were performed in 115 patients at our institution. A traditional open excision, a laparoscopic stapler resection or a different approach was used for the management of the distal ureter in 76, 27, and 11 cases, respectively. Clinical follow-up as well as perioperative and pathologic data were retrospectively collected.
• Results: Perioperative and pathologic data were available in all 116 cases. Clinical outcomes were available in 107 patients with a mean follow-up of 30.5 months (range 1 to 148). Six patients (5.6%) had a local recurrence develop, including 1 patient with port site metastasis (0.9%) at an average of 5.7 months. In 2 of these patients, violation of the ipsilateral urinary tract was noted perioperatively.
• Conclusions: We report, in this large single-center series of laparoscopic RNU, a low incidence of local recurrence. Our results confirm that a laparoscopic approach to upper tract TCC does not result in a clinically significant increased risk of tumor spillage provided that principles of oncologic surgery are followed.
  
  
• Editorial Comment
  Laparoscopy radical nephroureterectomy (LRNU) has been challenged and questioned as treatment of upper tract transitional cell carcinoma (TCC) due to the possible port or bladder cuff resection sites recurrence. Different authors demonstrated diverse methods to manage the bladder cuff during LRNU and similar recurrence rates and outcomes to the open technique have been reported. This single-center retrospective study (107 patients) demonstrated that the laparoscopic approach did not increase the risk of tumor spillage when principles of oncologic surgery are followed.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Center
Director of Minimally Invasive Urologic Oncology
Tony Grampsas Cancer Center, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@uchsc.edu