Extraperitoneal Laparoscopic Radical Nephroureterectomy and Lymph Node Dissection in Modified Supine Position - 09/09/17
Abstract |
Objective |
To explore the feasibility of extraperitoneal laparoscopic radical nephroureterectomy (EL-RNU) and lymph node dissection in a modified supine position for managing urothelial carcinomas in the renal pelvis or in the upper two-thirds of the ureter.
Patients and Methods |
Consecutively from January 2014 to October 2015, 15 patients with high-risk urothelial carcinoma in the renal pelvis or in the upper two-thirds of the ureter underwent EL-RNU and extraperitoneal laparoscopic lymph node dissection (EL-LND). Clinical and pathologic data, histologic nodal status, perioperative complications, and recurrence data were collected.
Results |
All of the 15 patients were treated with EL-RNU and EL-LND in a modified supine position, and none was converted to open surgery. The mean operation time was 178 ± 18 minutes. The mean estimated blood loss was 140 ± 40 mL. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 7 ± 1 days. Pathologic studies revealed positive lymph nodes in 3 patients (20%). The mean number of harvested lymph nodes was 12 ± 3. No local recurrence and distant metastasis were found after a median follow-up of 14.4 months (7-23 months).
Conclusion |
EL-RNU and EL-LND in the modified supine position are mini-invasive and feasible for patients with urothelial carcinoma in the renal pelvis or in the upper two-thirds of the ureter. Good exposure and dissection of the abdominal aorta and inferior vena cava and the integrity of the peritoneum are key to the operational success of this approach.
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| Pengchao Li, Jun Tao, and Xiaheng Deng contributed equally. |
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding support: This work was supported by the National Natural Science Foundation of China (grant nos. 81272832 and 81201997), by the Six Major Talent Peak Project of Jiangsu Province (grant nos. 2013-WS-033), by the Priority Academic Program Development of Jiangsu Higher Education Institutions (JX10231801), and by the Provincial Initiative Program for Excellency Disciplines of Jiangsu Province. |
Vol 107
P. 126-131 - septembre 2017 Retour au numéro
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