Retroperitoneal Laparoscopic Versus Open Radical Nephroureterectomy For Upper Tract Urothelial Carcinoma

Objective To compare retroperitoneal laparoscopic versus open radical nephroureterectomy for upper tract urothelial carcinoma with regard to perioperative and long oncologic outcomes.Methods From July 2005 to December 2016,105 radical nephroureterectomy were performed in our institution,Retrospective review of these patients,80 underwent retroperitoneal laparoscopic approach(RLNU group)and 25 to the open technique(ONU group),perioperative data and follow-up result was compared.Results As compared with the ONU group,the intraoperative blood loss was significantly less in the RLNU group〖[100(50~200)] ml vs.[150(100~700)] ml,(Z=-2.694,P=0.007)〗;the postoperative anal exhaust time was shorter in RLNU group[(2.6±0.6)d vs.(3.2±0.8)d,t=3.791,P=0.000];and the number of postoperative hospitalization days were shorter in RLNU group[(10.1±5.0)d vs.(14.3±9.3)d,t=2.189,P=0.038];Whereas there was no significant difference in operation time between the two groups[(220.6±68.5)min vs.(218.4±85.3)min,t=-0.130,P=0.897].Postoperative follow-up was 2~96 months,There were 18 cases and 5 cases recurrence of bladder cancer in the RLNU group and the ONU group during the follow-up,respectively,distant metastasis was found in 6 cases in the RLNU group and 0 case in the ONU group,and overall survival rate is no significant(P=0.491).Conclusion retroperitoneal Laparoscopic surgery is a safe and effective method to treat upper tract urothelial carcinoma.Objective To systematically evaluate the risk factors linked to intravesical recurrence afer radical nephroureterectomy.Method The clinical trials related to the risk factors of IVR in UTUC patients after radical nephroureterectomy were searched in Pub Med,Embase,The Cochrane Library(Issue 8,2017),CBM,CNKI,VIP and wanfang databases from inception to August 2017.The Meta-analysis was conducted by using Rev Man 5.3 software after two researchers independently screened the literature,extracted the data and evaluated the risk of bias of eligible studies.The results are expressed as hazard ratio(HR)and their corresponding 95% confidence interval(CI).Results A total of 23 studies were included in a total of 8614 patients with bladder cancer recurrence of 2193(25.5%).Meta-analysis showed that the previous of bladder cancer [HR = 1.77,95% CI(1.42-2.22),P <0.001],tumor stage(≥T2)[HR=1.41,95%CI(1.09-1.82),P=0.009],ureteral tumor[HR=1.34,95%CI(1.20-1.49),P<0.001],tumor multifocality[HR = 1.51,95% CI(1.34-1.69),P <0.001],lymphovascular invasion [HR = 1.43,95% CI(1.20-1.70),P <0.001],laparoscopic surgery [HR = 1.52,95% CI(1.08-2.15),P = 0.02],positive surgical margins[HR=1.87,95%CI(1.17-2.99),P=0.009],preoperative ureteroscopy [HR = 1.46,95% CI(1.21-1.75),P <0.001] were risk factors for IVR after RNU.Conclusions We identified the previous of Bca,ureteral tumor,tumor stage(≥T2),tumor multifocality,LVI,laparoscopic surgery,positive surgical margins and preoperative ureteroscopy were risk factors for IVR after RNU.