Simultaneous Laparoscopic Nephroureterectomy And Excision Of A Bladder-cuff For Upper Tract Urothelial Carcinoma

Objectives:In order to integrate the advantages of different surgical procedures for the treatment of the lower ureter in upper tract urothelial carcinoma(UTUC)operation,and in accordance with the principle of minimally invasive and non tumor,we have proposed an improved procedure for the treatment of the ureteral end.To investigate the clinical outcomes and safety of simultaneous laparoscopic nephroureterectomy and excision of a bladder-cuff for upper tract urothelial carcinoma.Method:Between October 2014 and September 2016 September,we retrospectively analyzed the clinical data of 43 patients who underwent laparoscopic nephroureterectomy for UTUC.There were 27 males(62.79%)and 16 females(37.21%),with 24 cases(55.81%)in the left side,19 cases in the right side(44.19%),23 cases(53.49%)of ureteral tumor,18 cases of renal pelvis tumor(41.86%),and 1 case of Multiple tumor(2.33%).17 cases(39.53%)underwent simultaneous laparoscopic nephroureterectomy and excision of a bladder-cuff(A group),and 26 cases(60.47%)underwent retroperitoneal laparoscopy combined with abdominal small incision operation(group B).In group A,the lateral oblique position was taken after the anesthetic took effect,and the upper part of the patient tilted back about 70 degrees.In group B patients need to replace the body position and continue the operation.During the operation,the ureter was found in front of the psoas and blocked by Hem-o-lok to prevent the urine from falling down.When the ureter was occluded and the urethra was cut through the urethra at the same time.The operative time,intraoperative blood loss,postoperative hospitalization days,cancer-specific survival(CSS),urothelial tumor-free survival(UTFS),and metastasis-free survival(MFS)were compared between the two operative methods.Results:The operations were successfully completed in all 43 patients.The average age of the two groups was 70.29 ± 8.70 years,67.15 ± 7.34 years.There was no statistical difference between the two groups of sex,the first diagnosis,the tumor location,the tumor pathological stage and the tumor pathological grade.Group A benefited from a shorter operation time(128.24±28.72 minutes vs 185.77±45.86 minutes,P<0.05),less intraoperative blood loss(100±53.03 ml vs 159.62±118.34 ml,P<0.01),a shorter postoperative hospital stay(5.53±1.18 days vs 7.31±2.29 days,P<0.05)compared to group B.No significant differences in cancer-specific survival(log rank test;P=0.657),urothelial tumor-free survival(log rank test;P=0.792),or metastasis-free surviva(log rank test;P=0.831)were found between the two groups.Conclusions:The simultaneous laparoscopic nephroureterectomy and excision of a bladder-cuff is a safe and effective method.In this modified operation,patients do not need to change their operative position,operation time loss,intraoperative blood loss and faster postoperative recovery.And the modified operation will not increase the rate oftumor recurrence and metastasis.However,long-term follow-up is required to obtain more clinical data for long-term prognosis.