Introduction

The standard surgical treatment of upper tract urothelial carcinoma is radical nephroureterectomy with complete excision of the ipsilateral bladder cuff. This was proposed by Kimball and Ferris in 1933 (1), after the authors found a high incidence of tumor in the remaining ureter following a radical nephrectomy for upper tract urothelial carcinoma. Some 40 years later, Strong and Pearse in 1976 quantified an average of 30% recurrence rate of urothelial carcinoma in the ureteral stump when incomplete nephroureterectomy was performed (2). Thus, a radical nephroureterectomy with complete excision of the bladder cuff is the standard surgical treatment of upper tract urothelial carcinoma (3,4).

In the open approach, the kidney is removed along with the ureter and its bladder cuff. The surgery can be performed with one large incision to remove the kidney, the ureter, and the bladder cuff. This is achieved through a midline or thoracoabdominal incision. Alternatively, two separate incisions can be made, i.e., a flank or subcostal and a Gibson incision.

Laparoscopic nephroureterectomy is becoming increasingly common as laparoscopic radical nephrectomy has now become the "gold standard" for the treatment of localized renal cell carcinoma (5). The advantages of laparoscopic radical nephrectomy over the open approach can also be applied to the laparoscopic nephroureterectomy. These include less intraoperative blood loss, less postoperative pain, faster recovery, and better cosmesis. However, to date there are few series reported with long-term follow-ups (6).

Although rare case reports of trocar site recurrence have been reported (7), the more crucial issue regarding oncologic control of laparoscopic nephroureterectomy is the management of the distal ureter and the bladder cuff.

As surgeons are attempting to keep the procedure as minimally invasive as possible, multiple techniques have been described.

0 0

Post a comment