Abstract
Background
Radical nephroureterectomy is considered as the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Laparoscopic radical nephroureterectomy (LNU) can be performed via the transperitoneal (TLNU) or retroperitoneal (RLNU) approach, and each one has its own advantages and limitations. Our study was conducted to describe the difference between TLNU and RLNU by comparing the perioperative outcomes.
Methods
From January 2009 to October 2014, 68 patients underwent TLNU or RLNU at our center were retrospectively collected and 1:1 matched for age, body mass index and tumor side. Baseline characteristics and perioperative outcomes were evaluated and compared, respectively.
Results
There were no significant differences between the TLNU and RLNU group in terms of baseline characteristics, operating time, estimated blood loss, visual analogue pain scale, cosmetic results, intraoperative and postoperative complication rate. Compared to TLNU approach, RLNU was associated with a quicker time to first oral intake (2.9 vs 2.0 days, p = 0.02) and hospital discharge (6.7 vs 5.6 days, p = 0.02).
Conclusion
Both transperitoneal and retroperitoneal laparoscopic approaches are safe and effective methods for treatment of UTUC. Retroperitoneal approach has the advantage in terms of quicker bowel recovery and shorter hospital discharge.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300
Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29
Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM (1991) Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1:343–349
Hanna N, Sun M, Trinh Q-D, Hansen J, Bianchi M, Montorsi F, Shariat SF, Graefen M, Perrotte P, Karakiewicz PI (2012) Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol 61:715–721
Sugihara T, Yasunaga H, Yu C, Horiguchi H, Nishimatsu H, Fushimi K, Kattan MW, Homma Y (2014) Perioperative outcome comparisons between open and laparoscopic nephroureterectomy among a population-based cohort from 2010 to 2012. J Endourol 29(7):770–776
Ni S, Tao W, Chen Q, Liu L, Jiang H, Hu H, Han R, Wang C (2012) Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 61:1142–1153
Rassweiler JJ, Schulze M, Marrero R, Frede T, Redorta JP, Bassi P (2004) Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: Is it better than open surgery? Eur Urol 46:690–697
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Fang Z, Li L, Wang X, Chen W, Jia W, He F, Shen C, Ye G (2014) Total retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection for upper urinary tract transitional cell carcinoma. J Investig Surg 27:354–359
Fan X, Xu K, Lin T, Liu H, Yin Z, Dong W, Huang H, Huang J (2013) Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 111:611–621
Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153:111–119
Rassweiler J, Frede T, Henkel TO, Stock C, Alken P (1998) Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol 33:489–496
Munch L, Gill I, McRoberts J (1994) Laparoscopic retroperitoneal renal cystectomy. J Urol 151:135–138
Liu P, Fang D, Xiong G, Yang K, Zhang L, Yao L, Zhang C, Li X, He Z, Zhou L (2015) A novel and simple modification for management of distal ureter during laparoscopic nephroureterectomy without patient repositioning: a bulldog clamp technique and description of modified port placement. J Endourol 30(2):195–200
Gonzalez CM, Batler RA, Schoor RA, Hairston JC, Nadler RB (2001) A novel endoscopic approach towards resection of the distal ureter with surrounding bladder cuff during hand assisted laparoscopic nephroureterectomy. J Urol 165:483–485
Chung S-D, Huang C-Y, Wang S-M, Chueh S-C, Hung S-F, Tsai Y-C, Yu H-J (2010) Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique. Surg Innov 1553350610387282
Xylinas E, Rink M, Cha EK, Clozel T, Lee RK, Fajkovic H, Comploj E, Novara G, Margulis V, Raman JD (2014) Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 65:210–217
Fang Z, Li L, Wang X, Chen W, Jia W, He F, Shen C, Ye G (2014) Total retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection for upper urinary tract transitional cell carcinoma. J Invest Surg 27:354–359
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Wentao Liu, Yinhuai Wang, Zhaohui Zhong, Hongyi Jiang, Shifeng Ouyang, Liang Zhu, Ran Xu have no conflict of interest to declare.
Rights and permissions
About this article
Cite this article
Liu, W., Wang, Y., Zhong, Z. et al. Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes. Surg Endosc 30, 5537–5541 (2016). https://doi.org/10.1007/s00464-016-4922-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-4922-x