Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: oncological outcomes at 7 years.

PURPOSE: We present long-term oncological outcomes following laparoscopic nephroureterectomy for upper tract transitional cell carcinoma.

MATERIALS AND METHODS: Between December 1997 and August 2005, 100 patients underwent laparoscopic nephroureterectomy for upper tract transitional cell carcinoma at our institution. Data were obtained from a prospectively maintained database, patient charts, telephone followup and a review of the Social Security Death Index.

RESULTS: Median patient age at surgery was 73 years. Final pathological stage was pTis/pTa in 28% of patients, pT1 in 31%, pT2 in 13%, pT3 in 24% and pT4 in 4%. High grade lesions were present in 58% of patients, multifocal disease was present in 23% and lymphovascular invasion was present in 9%. Positive surgical margins occurred in 7 patients (7%). Median followup was 7 years (range 2 to 10). At 2, 5 and 7 years overall survival was 81%, 59% and 50%, cancer specific survival was 91%, 77% and 72%, and recurrence-free survival was 66%, 50% and 36%, respectively. Five-year cancer specific survival by stage was 80% for pTis/Ta, 70% for pT1, 68% for pT2, 60% for pT3 and 0% for pT4. On univariate analysis nonorgan confined disease and lymphovascular invasion affected cancer specific survival (p = 0.01 and 0.04, respectively). On multivariate analysis only nonorgan confined disease was a significant factor (p = 0.04). Concomitant bladder tumor at diagnosis was associated with poor recurrence-free survival on univariate and multivariate analysis (p = 0.02 and 0.01, respectively).

CONCLUSIONS: To our knowledge the largest long-term followup after laparoscopic nephroureterectomy for upper tract transitional cell carcinoma is presented. Long-term oncological outcomes appear comparable to those of open surgery.