Top

Surgical Endoscopy

Published in:

01-12-2016

Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes

Authors: Wentao Liu, Yinhuai Wang, Zhaohui Zhong, Hongyi Jiang, Shifeng Ouyang, Liang Zhu, Ran Xu

Published in: Surgical Endoscopy | Issue 12/2016

Abstract

Background

Radical nephroureterectomy is considered as the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Laparoscopic radical nephroureterectomy (LNU) can be performed via the transperitoneal (TLNU) or retroperitoneal (RLNU) approach, and each one has its own advantages and limitations. Our study was conducted to describe the difference between TLNU and RLNU by comparing the perioperative outcomes.

Methods

From January 2009 to October 2014, 68 patients underwent TLNU or RLNU at our center were retrospectively collected and 1:1 matched for age, body mass index and tumor side. Baseline characteristics and perioperative outcomes were evaluated and compared, respectively.

Results

There were no significant differences between the TLNU and RLNU group in terms of baseline characteristics, operating time, estimated blood loss, visual analogue pain scale, cosmetic results, intraoperative and postoperative complication rate. Compared to TLNU approach, RLNU was associated with a quicker time to first oral intake (2.9 vs 2.0 days, p = 0.02) and hospital discharge (6.7 vs 5.6 days, p = 0.02).

Conclusion

Both transperitoneal and retroperitoneal laparoscopic approaches are safe and effective methods for treatment of UTUC. Retroperitoneal approach has the advantage in terms of quicker bowel recovery and shorter hospital discharge.

Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300CrossRefPubMed

Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29CrossRefPubMed

Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM (1991) Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1:343–349CrossRefPubMed

Hanna N, Sun M, Trinh Q-D, Hansen J, Bianchi M, Montorsi F, Shariat SF, Graefen M, Perrotte P, Karakiewicz PI (2012) Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol 61:715–721CrossRefPubMed

Sugihara T, Yasunaga H, Yu C, Horiguchi H, Nishimatsu H, Fushimi K, Kattan MW, Homma Y (2014) Perioperative outcome comparisons between open and laparoscopic nephroureterectomy among a population-based cohort from 2010 to 2012. J Endourol 29(7):770–776CrossRefPubMed

Ni S, Tao W, Chen Q, Liu L, Jiang H, Hu H, Han R, Wang C (2012) Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 61:1142–1153CrossRefPubMed

Rassweiler JJ, Schulze M, Marrero R, Frede T, Redorta JP, Bassi P (2004) Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: Is it better than open surgery? Eur Urol 46:690–697CrossRefPubMed

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed

Fang Z, Li L, Wang X, Chen W, Jia W, He F, Shen C, Ye G (2014) Total retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection for upper urinary tract transitional cell carcinoma. J Investig Surg 27:354–359CrossRef

10.

Fan X, Xu K, Lin T, Liu H, Yin Z, Dong W, Huang H, Huang J (2013) Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 111:611–621CrossRefPubMed

11.

Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153:111–119CrossRefPubMed

12.

Rassweiler J, Frede T, Henkel TO, Stock C, Alken P (1998) Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol 33:489–496CrossRefPubMed

13.

Munch L, Gill I, McRoberts J (1994) Laparoscopic retroperitoneal renal cystectomy. J Urol 151:135–138PubMed

14.

Liu P, Fang D, Xiong G, Yang K, Zhang L, Yao L, Zhang C, Li X, He Z, Zhou L (2015) A novel and simple modification for management of distal ureter during laparoscopic nephroureterectomy without patient repositioning: a bulldog clamp technique and description of modified port placement. J Endourol 30(2):195–200CrossRefPubMed

15.

Gonzalez CM, Batler RA, Schoor RA, Hairston JC, Nadler RB (2001) A novel endoscopic approach towards resection of the distal ureter with surrounding bladder cuff during hand assisted laparoscopic nephroureterectomy. J Urol 165:483–485CrossRefPubMed

16.

Chung S-D, Huang C-Y, Wang S-M, Chueh S-C, Hung S-F, Tsai Y-C, Yu H-J (2010) Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique. Surg Innov 1553350610387282

17.

Xylinas E, Rink M, Cha EK, Clozel T, Lee RK, Fajkovic H, Comploj E, Novara G, Margulis V, Raman JD (2014) Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 65:210–217CrossRefPubMed

18.

Title: Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes
Authors: Wentao Liu
Yinhuai Wang
Zhaohui Zhong
Hongyi Jiang
Shifeng Ouyang
Liang Zhu
Ran Xu
Publication date: 01-12-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-4922-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2016

Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?

Clinical outcomes and cost–benefit analysis comparing laparoscopic and robotic colorectal surgeries

Laparoscopic incisional hernia repair after colorectal surgery. Is it possible to maintain a mini-invasive approach?

Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer

Minimal-invasive approach for penetrating Crohn’s disease is not associated with increased complications

Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett’s esophagus