Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: the Taiwan Robot Urological Surgery Team (TRUST) experience

World Journal of Surgical Oncology

Yeong-Shiau Pu²  Chao-Yuan Huang²  Yen-Chuan Ou³  Wei-Che Wu¹  Shun-Fa Hung¹  Shiu-Dong Chung¹  Chen-Kuang Yang³ 

[1] Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Nanya South Road, New Taipei City 220, Taiwan;Department of Urology, School of Medicine, College of Medicine, National Taiwan University, 1 Roosevelt Road, Taipei 10617, Taiwan;Division of Urology, Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Taichung 40705, Taiwan

关键词: Laparoscopy;    Robot;    Ureter;    Kidney;    Urothelial carcinoma;   

Others  :  1148665
DOI  :  10.1186/1477-7819-12-219

 received in 2014-01-01, accepted in 2014-07-04,  发布年份 2014

【 摘 要 】

Background

To report Taiwan’s experience in robot-assisted laparoscopic nephroureterectomy (RANU) for upper tract urothelial carcinoma (UTUC).

Methods

Twenty patients with a diagnosis of renal pelvic or ureteral urothelial carcinoma underwent RANU at three medical centers. We performed RANU by re-docking the robot after the nephrectomy with or without repositioning for excision of the distal ureter and bladder cuff.

Results

From November 2010 to July 2013, a total of 20 patients with a mean age of 70.1 +/- 9.9 years (range 43 to 92 years) and mean body mass index (BMI) of 22.9 +/-3.8 kg/m² underwent RANU for renal pelvic or ureteral urothelial carcinoma. Mean operative time was 251.6 +/- 126.7 minutes (range 110 to 540 minutes), estimated blood loss was 50.0 +/- 42.9 mL (range 10 to 200 mL), and mean length of hospital stay was 6.7 +/- 2.4 days (range 4 to 12 days). Pathology data revealed 19 high and one low-grade urothelial carcinoma and staged Ta for three, T1 for five, T2 for five and T3 for seven. With a mean follow-up of 14.7 months (range 2 to 34 months), three intravesical recurrences developed in the bladder, and four of them also developed metastatic disease.

Conclusions

The TRUST early experience showed that RANU is a safe and feasible minimally invasive procedure for UTUC.

【 授权许可】

   
2014 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM: Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1991, 1:343-349.
• [2]Yang MH, Chen KK, Yen CC, Wang WS, Chang YH, Huang WJ, Fan FS, Chiou TJ, Liu JH, Chen PM: Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology 2002, 59:681-687.
• [3]Chung SD, Huang KH, Lai MK, Huang CY, Chen CH, Pu YS, Yu HJ, Chueh SC: CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Am J Kidney Dis 2007, 50:743-753.
• [4]Lai MN, Wang SM, Chen PC, Chen YY, Wang JD: Population-based case–control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk. J Natl Cancer Inst 2010, 102:179-186.
• [5]Chen CH, Dickman KG, Huang CY, Moriya M, Shun CT, Tai HC, Huang KH, Wang SM, Lee YJ, Grollman AP, Pu YS: Aristolochic acid-induced upper tract urothelial carcinoma in Taiwan: clinical characteristics and outcomes. Int J Cancer 2013, 133:14-20.
• [6]Berger A, Haber GP, Kamoi K, Aron M, Desai MM, Kaouk JH, Gill IS: Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: oncological outcomes at 7 years. J Urol 2008, 180:849-854.
• [7]Stewart GD, Humphries KJ, Cutress ML, Riddick AC, McNeill SA, Tolley DA: Long-term comparative outcomes of open versus laparoscopic nephroureterectomy for upper urinary tract urothelial-cell carcinoma after a median follow-up of 13 years. J Endourol 2011, 25:1329-1335.
• [8]Walton TJ, Novara G, Matsumoto K, Kassouf W, Fritsche HM, Artibani W, Bastian PJ, Martínez-Salamanca JI, Seitz C, Thomas SA, Ficarra V, Burger M, Tritschler S, Karakiewicz PI, Shariat SF: Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int 2011, 108:406-412.
• [9]Chung SD, Chueh SC, Lai MK, Huang CY, Pu YS, Yu HJ, Huang KH: Long-term outcome of hand-assisted laparoscopic radical nephroureterectomy for upper-tract urothelial 15 carcinoma: comparison with open surgery. J Endourol 2007, 21:595-599.
• [10]Chung SD, Kelle JJ, Huang CY, Chen YH, Lin HC: Comparison of 90-day re-admission rates between open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot-assisted laparoscopic prostatectomy (RALP). BJU Int 2012, 110:E966-971.
• [11]Ou YC, Yang CR, Wang J, Cheng CL, Patel VR: Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by a single surgeon. Asian J Surg 2011, 34:74-80.
• [12]Park SY, Jeong W, Ham WS, Kim WT, Rha KH: Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int 2009, 104:1718-1721.
• [13]Rose K, Khan S, Godbole H, Olsburgh J, Dasgupta P: Robotic assisted retroperitoneoscopic nephroureterectomy - first experience and the hybrid port technique. Int J Clin Pract 2006, 60:12-14.
• [14]Nanigian DK, Smith W, Ellison LM: Robot-assisted laparoscopic nephroureterectomy. J Endourol 2006, 20:463-465.
• [15]Hu JC, Silletti JP, Williams SB: Initial experience with robot-assisted minimally-invasive nephroureterectomy. J Endourol 2008, 22:699-704.
• [16]Eandi JA, Nelson RA, Wilson TG, Josephson DY: Oncologic outcomes for complete robot-assisted laparoscopic management of upper-tract 16 transitional cell carcinoma. J Endourol 2010, 24:969-975.
• [17]Hemal AK, Stansel I, Babbar P, Patel M: Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 2011, 78:357-364.
• [18]Pugh J, Parekattil S, Willis D, Stifelman M, Hemal A, Su LM: Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series. BJU Int 2013, 112:E295-300.
• [19]Lim SK, Shin TY, Kim KH, Chung BH, Hong SJ, Choi YD, Rha KH: Intermediate-term outcomes of robot-assisted laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma. Clin Genitourin Cancer 2013, 11:515-521.