TY - JOUR
T1 - A comparative study of different surgical techniques for the management of distal ureter during laparoscopic radical nephroureterectomy
AU - Morote, J.
AU - Ribal, M. J.
AU - Costa-Grau, M.
AU - Raventós, C.
AU - Huguet, J.
AU - Alcaraz, A.
AU - Carrion, A.
AU - Lozano, F.
N1 - Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - © 2019 AEU Objectives: To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). Material and methods: Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007-2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). Results: A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3-120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (P =.961), distant/local recurrence (P =.955) nor CSS (P =.802). The open extravesical approach was not related to bladder recurrence (P =.12) but increased distant/local recurrence (P =.045) and decreased CSS (P =.034) compared to intravesical approach. Conclusions: LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical.
AB - © 2019 AEU Objectives: To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). Material and methods: Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007-2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). Results: A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3-120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (P =.961), distant/local recurrence (P =.955) nor CSS (P =.802). The open extravesical approach was not related to bladder recurrence (P =.12) but increased distant/local recurrence (P =.045) and decreased CSS (P =.034) compared to intravesical approach. Conclusions: LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical.
KW - Laparoscopic radical nephroureterectomy
KW - Upper urinary tract urothelial carcinoma
KW - Ureteral endoscopic detachment
KW - Management of distal ureter
KW - Oncological outcomes
UR - http://www.mendeley.com/research/comparative-study-different-surgical-techniques-management-distal-ureter-during-laparoscopic-radical
UR - https://dialnet.unirioja.es/servlet/articulo?codigo=7152371
U2 - 10.1016/j.acuro.2019.07.001
DO - 10.1016/j.acuro.2019.07.001
M3 - Article
C2 - 31447089
SN - 0210-4806
VL - 43
SP - 543
EP - 550
JO - Actas Urologicas Espanolas
JF - Actas Urologicas Espanolas
IS - 10
ER -