Oncological outcomes of laparoscopic nephroureterectomy with pluck method for distal ureter resection

Abstract

Objective: To report the oncologic outcomes of upper tract urothelial carcinoma treated with laparoscopic nephroureterectomy and pluck method for distal ureter resection. Materials and methods: Between May 2004 and November 2015, 118 patients with upper urinary tract urothelial carcinoma received laparoscopic radical nephroureterectomy with endoscopic bladder cuff excision at our institution. The medical records were reviewed retrospectively for clinical and pathological results. Cox regression analyses were performed on factors related to oncological outcomes. Results: The median follow-up was 26 months. Bladder recurrence was found in 27 patients (22.9%), extravesical retroperitoneal recurrence in four patients (3.4%), and metastases in 17 patients (14.4%). Multivariate analyses showed that male sex was associated with higher bladder recurrence [odds ratio (OR)=2.2; 95% confidence interval (CI), 1.02–4.78; p=0.045)], tumor size had significant correlation with locoregional recurrence (OR=1.29; 95% CI, 1.07–3.43; p=0.029), tumor stage was significantly correlated with subsequent metastasis (OR=2.08; 95% CI, 1.21–3.56; p=0.008) and overall survival (OR=1.84; 95% CI, 1.06–3.22 ; p=0.031), and tumor size correlated significantly with cancer-specific survival (OR=2.57; 95% CI, 1.16–5.72; p=0.021). Conclusions: Tumor size and tumor stage were significantly associated with survival (cancer-specific and overall survival) in patients receiving nephroureterectomy with pluck method.

Keywords

• laparoscopic surgery
• recurrence
• renal pelvis
• transitional cell carcinoma
• ureter
• urinary bladder neoplasms