Follow-up results of a pure retroperitoneoscopic/extraperitoneal nephroureterectomy for upper tract urothelial tumors

We present the results of a pure retroperitoneoscopic/ extraperitoneal nephroureterectomy (RENU) for upper urinary tract transitional cell cancer (UT-TCC). After establishment of RENU in benign indications (n=21 Patients), 14 patients (age range 51-92 years, mean 71.6) with UT-TCC have undergone the technique in our clinic from October 2005 to October 2008. This paper reports the operative procedure, clinical results and follow up. Total operative time was 110-240 minutes (median 154.5). Average blood loss was 132 mL. Tumor localization in oncology patients was renal pelvis (63.6%), ureter (18.2%) or both (18.2%). Postoperative tumor stages were Ta (n=2), Tis (n=2), T1 (n=3), T2 (n=3) and T3 (n=4) without lymph node involvement. No perioperative complications were observed. Urethral catheters were removed on Day 6-8 post surgery (median Day 7). Recovery to normal life activity ranged from 8 to 30 days (mean 17.8). During the 4-36 month (median 23) follow-up period, there was one mortality due to cancer progression. Four patients had developed superficial bladder cancer disease requiring regular cystoscopic resections. One patient had coincidental Bellini duct renal tumor and developed psoas metastasis after eight months. The 2-year tumor specific survival rate is 91%. The retroperitoneoscopic/ extraperitoneal nephroureterectomy is a lowrisk and minimally invasive procedure to be used whenever nephroureterectomy is indicated. It is an attractive alternative to both laparoscopic and open techniques and adheres to the oncological principles of radical nephroureterectomy. Short-term follow-up data showed no increased risk of tumor recurrence. However, long-term results are needed before this technique can be established as standard UT-TCC therapy.