Does the management of the
distal ureter at Laparoscopic
Nephroureterectomy affect early
surgical outcome?
Khafagy R, Nilsen-Nunn A, Harikrishnan
J, Cartledge J, Jain S
Pyrah Department of Urology, St.James Hospital, Leeds
Materials & Methods
• 55 patients:
– Age range 47 – 83 (median 71 yrs)
– 52.5 % were male
• 15 patients had a prior history of bladder TCC
• Post-op comparisons were made between the 3
different operative groups:
– Laparoscopic only (LAP ONLY)
– Laparoscopic with an open lower end dissection
outside of the bladder (LAP EXTRA)
– Laparoscopic with opening of the bladder (LAP
TRANS)
• LAP ONLY: 32 patients
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–
–
–
Median stay 6 days
5 patients complications before discharge
9 patients had complications within 30 days
There were 5 deaths by 12 months
• LAP TRANS: 12 patients
– Median stay 7 days
– 1 patient had complication before discharge
– There were no deaths by 12 months
• LAP EXTRA: 11 patients
– Median stay 7.5 days
– 4 patients had complications within 30 days
– There was 1 death by 12 months
Discussion
• Short term data suggests there is no difference in
morbidity between each of the 3 approaches.
• The comparative oncological outcomes between the
three approaches requires longer patient follow up
• Twelve month cancer mortality is higher for the LAP
ONLY group perhaps suggesting an early
oncological difference between this and the other
two more radical approaches.
• Should there be improved survival from undertaking
the LAP TRANS approach, this would suggest that
approach should be adopted more widely