Berger Andre, Fergany Amr
Section of Laparoscopic and Robotic Surgery, Cleveland Clinic Foundation, Glickman Urological Institute, Cleveland, OH 44195, USA.
Adv Urol. 2009;2009:826725. doi: 10.1155/2009/826725. Epub 2008 Nov 5.
Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC). Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU). Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.
引言。腹腔镜根治性肾输尿管切除术（LNU）在世界各地的多个中心开展得越来越多。我们回顾了LNU手术后的肿瘤学结局以及远端输尿管的处理技术。材料与方法。对有关LNU治疗上尿路移行细胞癌（TCC）时远端输尿管的肿瘤学结局及处理的文献进行了全面综述。结果与讨论。上尿路TCC的LNU可通过单纯腹腔镜手术（LNU）或手辅助（HALNU）进行。远端输尿管的处理仍存在争议。与开放手术相比，LNU似乎具有更好的围手术期结局。LNU术后的中期肿瘤学结局与开放性肾输尿管切除术（ONU）相当。结论。肾输尿管切除术中远端输尿管和膀胱袖口的切除仍存在争议。LNU的中期肿瘤学结局与ONU相比良好。初步的长期肿瘤学结局令人鼓舞。需要对LNU和开放手术进行前瞻性随机比较，以确定这些术式在当前背景下的作用。
