Tumor Recurrence Incidence Following Hand-Assisted Laparoscopic Nephroureterectomy

BACKGROUND AND OBJECTIVES: We evaluated the incidence of tumor recurrence following hand-assisted laparoscopic nephroureterectomy (HALNU) for the treatment of upper tract urothelial carcinoma. METHODS: The medical records of consecutive patients who underwent HALNU by a single surgeon (CW) between October 2001 and May 2005 were reviewed. The ureter was clipped before kidney dissection to prevent distal migration of tumor. Following liberation of the kidney, the bladder cuff and intramural ureter were excised by using a Collings knife under cystoscopic guidance. RESULTS: Ten patients were identified. The primary location of disease was confined to the intrarenal collecting system. Eight high-grade (HG) and 2 low-grade (LG) tumors were removed, with pT3 (6), pT2 (1), pT1 (1), and pTa (2) disease. The patient having a LG pTa urothelial carcinoma developed pulmonary metastasis 20 months following surgery and survived an additional 26 months. Two patients, each having a HG pT3 tumor, developed a urothelial carcinoma in the bladder contralateral to the site of ureteral excision. At a mean follow-up of 41 months, there has been no evidence of tumor recurrence in the pelvis. CONCLUSION: Our technique of HALNU does not appear to harbor an increased risk for urothelial carcinoma recurrence.