Retroperitoneoscopic Nephroureterectomy for Upper Urinary Tract Cancer: A Comparative Study with Conventional Open Retroperitoneal Nephroureterectomy

Purpose: To compare the outcomes of retroperitoneoscopic nephroureterectomy (RNU) with those of open retroperitoneal nephroureterectomy (ORNU) for upper urinary tract cancer. Patients and Methods: This study included 240 consecutive patients who received a clinical diagnosis of localized upper urinary tract cancer and underwent nephroureterectomy by a retroperitoneal approach. Of these, 120 patients underwent RNU and 120 patients underwent ORNU. Results: The mean operative time for RNU (346 min) was significantly longer than that for ONU (209 min), despite the lack of a significant difference in the estimated blood loss between these two groups. Significant differences were observed in parameters related to postoperative recovery between the groups, including the time to walk (1.8 versus 2.3 days), the time to oral intake (1.8 versus 2.7 days), and the time until permission for discharge (9.9 versus 13.4 days). There were no significant differences in the major pathologic factors between the groups. Furthermore, the incidences of intravesical as well as extravesical recurrence between the RNU and ORNU groups were similar, and there were no significant differences in cause-specific and overall survivals between the groups. Among patients with grade 3 disease, cause-specific survivals in patients undergoing RNU were significantly poorer than those in patients undergoing ORNU, while there was no significant difference in the overall survival between the groups. Multivariate analysis, however, indicated that the surgical procedure (RNU versus ORNU) could not be an independent predictor of both overall and cancer-specific survivals irrespective of tumor grade. Conclusions: RNU represents an effective, safe, and less invasive management option for upper urinary tract cancer and achieves a cancer control rate similar to that of ORNU; however, it is necessary to perform further investigations to determine the optimal indications for RNU for patients with high-grade disease.