Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy.

BACKGROUND AND PURPOSE

The optimal approach for management of the distal ureter and bladder cuff (DUBC) during laparoscopic nephroureterectomy (LNU) for upper-tract transitional-cell carcinoma (TCC) is controversial. We describe our contemporary experience with LNU and compare several approaches to the DUBC.

PATIENTS AND METHODS

A retrospective analysis was performed on 36 patients undergoing LNU. Three approaches to the DUBC were used: Open resection (OR), complete laparoscopic dissection and suture reconstruction (LR), and laparoscopic dissection with DUBC stapling (LS). Patient demographics and intraoperative, perioperative, and pathologic variables were compared. Estimated 2-year recurrence-free survival (RFS) was calculated.

RESULTS

A total of 36 patients were analyzed: 10 OR, 12 LR, and 14 LS. The mean age was 69.6 years with a mean follow-up of 15 months. The LR and LS groups had significantly shorter operative times compared with the OR group (163 and 152 vs 276 minutes, respectively (P<0.05). The LR group had the shortest mean length of stay compared with the OR and LS groups (2.0 vs 3.5 and 2.7 days, respectively, P<0.05). No patient had a complete ureteral orifice, but a cystoscopically appreciable remnant of the resected ureteral orifice was noted in 50% of the LS group vs none with the LR and OR groups (P<0.05). The estimated 2-year RFS was 65% for the entire cohort with no significant differences among groups.

CONCLUSIONS

Complete laparoscopic resection of the DUBC is feasible, particularly in low-stage, low-grade upper tract TCC and provides benefits such as shorter operative times and length of stay compared with an open bladder cuff excision.