Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up.

OBJECTIVE: To compare the oncological outcomes of laparoscopic radical nephroureterectomy (LNU) vs open NU (ONU) for upper urinary tract transitional cell carcinoma (TCC).

PATIENTS AND METHODS: Between July 1999 and January 2003, we performed 70 LNUs and 70 ONUs for TCC of the upper urinary tract. ONU was reserved for patients with previous abdominal surgery or with severe cardiac and/or pulmonary problems. Demographic data, tumour staging and histological grading and rates of metastasis were recorded and compared.

RESULTS: For LNU and ONU the mean operative durations were 240 min and 190 min, respectively. The definitive pathology showed a high incidence of tumour stage pT2 G2 in both LNU and ONU groups. The median follow-up was 60 months. In the LNU group, the 5-year disease-free survival (DFS) was 75%: 100% for pTa, 88% for pT1, 78% for pT2, and 35% for pT3 (P < 0.001). In the ONU group, the 5-year DFS was 73% (LNU vs ONU, P = 0.037): 100% for pTa, 89% for pT1, 75% for pT2 and 31% for pT3 (P < 0.001).

CONCLUSION: The results of our long-term controlled study support the use of LNU as an effective alternative to ONU in the therapy of upper urinary tract urothelial cancer.