Long-Term Outcome of Hand-Assisted Laparoscopic Nephroureterectomy for Pathologic T3 Upper Urinary Tract Urothelial Carcinoma

Purpose: To determine the feasibility and long-term outcomes of hand-assisted laparoscopic nephroureterectomy (HALNU) compared with open nephroureterectomy (ONU) in the management of pT3N0 upper urinary tract urothelial carcinoma (UUT-UC). Patients and Methods: Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT3N0 UTT-UC were matched and compared with 31 patients who underwent ONU. The oncologic out-comes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival, were statistically analyzed. Results: The median follow-up period in the HALNU group was 72 months (range 33–111 months) and 115 months in the ONU group (range 24–161 months). Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 mL versus 487 mL; P = 0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancer-specific survival, and overall survival were also comparable in both groups. Conclusions: HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT3N0UUT-UC.