Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China
Objective: We compared long-term clinical outcomes of upperurinary tract transitional cell carcinoma (TCC) patients treated byretroperitoneoscopic nephroureterectomy (RNU) or open radicalnephroureterectomy (ONU).
Methods: Upper urinary tract TCC patients were treated with RNU(n = 86) or ONU (n = 72) and followed-up for more than threeyears. Demographic and clinical data, including preoperativeindexes, intraoperative indexes and long-term clinical outcomes,were retrospectively compared to determine long-term efficacy ofthe two procedures.
Results: The RNU and ONU groups were statistically similar inage, gender, previous bladder cancer history, tumour location,pathologic tumour stage, pathologic node metastasis or tumourpathologic grade. The original surgery time required for both RNUand ONU was statistically similar, but RNU was associated witha significantly smaller volume of intraoperative estimated bloodloss and shorter length of postoperative hospital stay. Follow-up(average: 42.4 months, range: 3-57) revealed that the RNU 3-yearrecurrence-free survival rate was 62.8% and the 3-year cancerspecific survival rate was 80.7%. In the ONU group, the 3-yearrecurrence-free survival and the three-year cancer-specific survivalrates were 59.2% and 80.3%, respectively. Neither of the survivalrates were statistically different between the two groups. T stage,grade, lymph node metastasis and bladder tumour history wererisk factors for tumour recurrence; the operation mode and thebladder cuff incision mode had no correlation with the recurrencefreesurvival.
Conclusion: The open surgery strategy and the retroperitoneoscopicnephroureterectomy strategy are equally effective for treating upperurinary tract TCC. However, the RNU procedure is less invasive,and requires a shorter duration of postoperative hospitalized care;thus, RNU is recommended as the preferred strategy.
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