Long-term outcome of hand-assisted laparoscopic radical nephroureterectomy for upper-tract urothelial carcinoma: Comparison with open surgery

Purpose: To evaluate the efficacy and long-term outcome of hand-assisted laparoscopic radical nephroureterectomy (HALNU) in treating upper urinary-tract transitional-cell carcinoma (UT-TCC). Patients and Methods: We analyzed the data from 39 patients who underwent HALNU in our institution between January 1999 and December 2002 for urothelial carcinoma of the ureter or kidney. Preoperative and perioperative data were collected retrospectively by reviewing medical records. The oncologic outcomes, including bladder recurrence-free survival, cancer-specific survival, and overall survival, were compared with those of 36 contemporary patients undergoing conventional open radical nephroureterectomy (ONU). The median follow-up was 48 months (range 6 2 months) in the HALNU group and 59.5 months in the ONU group (range 8 8 months). Patients ages, sex, body mass index, pathologic parameters, and American Society of Anesthesiologists (ASA) classification showed no significant difference between the groups. Results: The HALNU group had statistically less blood loss (183 mL v 422 mL; P = 0.02). The average hospital stay and dose of narcotic analgesics were significantly less in the HALNU group. The complication rates were similar (12.8% for HALNU and 8.3% for ONU; P = 0.53). The 5-year bladder recurrence-free survival, cancer-specific survival, and overall survival were similar in the two groups. Conclusions: The HALNU is a less-invasive technique with 5-year bladder recurrence-free survival, cancer-specific survival, and overall survival rates similar to those of ONU for patients with UT-TCC.