TY - JOUR
T1 - Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma
T2 - Outcomes of an international multi-institutional study of 101 patients
AU - Park, Sung Yul
AU - Rha, Koon Ho
AU - Autorino, Riccardo
AU - Derweesh, Ithaar
AU - Liastikos, Evangelos
AU - Tsai, Yao Chou
AU - Seo, Ill Young
AU - Nagele, Ugo
AU - Abdel-Karim, Aly M.
AU - Herrmann, Thomas
AU - Han, Deok Hyun
AU - Rais-Bahrami, Soroush
AU - Lee, Seung Wook
AU - Kim, Kyu Shik
AU - Fornara, Paolo
AU - Kallidonis, Panagiotis
AU - Springer, Christopher
AU - Élsalmy, Salah
AU - Chueh, Shih Chieh Jeff
AU - Ho, Chen Hsun
AU - Panumatrassamee, Kamol
AU - Kopp, Ryan
AU - Stolzenburg, Jens Uwe
AU - Richstone, Lee
AU - Chung, Jae Hoon
AU - Shin, Tae Young
AU - Greco, Francesco
AU - Kaouk, Jihad H.
PY - 2013/9
Y1 - 2013/9
N2 - Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.
AB - Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.
KW - LESS
KW - laparoendoscopic single-site surgery
KW - multi-institutional
KW - transitional cell carcinoma
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U2 - 10.1111/j.1464-410X.2012.11775.x
DO - 10.1111/j.1464-410X.2012.11775.x
M3 - Article
C2 - 23469990
AN - SCOPUS:84882243957
SN - 1464-4096
VL - 112
SP - 610
EP - 615
JO - BJU international
JF - BJU international
IS - 5
ER -