Clinical application of one-position complete retroperitoneal laparoscopic radical resection of renal pelvis and ureteral carcinoma

Background: To explore the surgical technique and the clinical efficacy of complete retroperitoneal laparoscopic radical resection in patients with upper tract urothelial carcinoma (UTUC).Methods: A total of 11 patients (6 males and 5 females) newly diagnosed with UTUC with T1/T2 were enrolled in this study who underwent one-position complete retroperitoneal laparoscopic radical resection in our hospital from March 2016 to December 2018. Among them, 8 cases were of renal pelvis carcinoma and 3 cases were of ureteral carcinoma. The average age was 57.5 years (range, 44-78 years). All patients were presented with painless gross hematuria. CTU and ureteroscopy were used to diagnose.Results All the 11 patients had successful operations without open transition. The mean operating time was 85 min (range 60 to 115 min). The mean amount of intraoperative bleeding was below 90 ml. The postoperative hospital stay was 3-7 days, with an average of 5 days. There was no obvious complication after operation. No local tumor recurrence or new bladder implantation metastasis has already been observed with the postoperative follow-up time in 8 to 40 months.Conclusion One-position complete retroperitoneal laparoscopic radical resection of UTUC is safe and feasible. The curative effect is affirmative. It has the conspicuous advantages in less bleeding during operation, minimally invasive, no posture change, quicker recovery with little disturbance of abdominal organ and shorter postoperative hospital stay, which could particularly reduce workload of operating room nurses, without any extra postoperative complications.

Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

Few studies have analyzed the details of neoadjuvant chemotherapy (NAC)-induced changes in patients with upper tract urothelial carcinoma. This study aimed to describe the impact of down-grading ipsilateral hydronephrosis by NAC for ureteral carcinoma. An observational study was conducted in 32 patients with cT1-3N0M0 ureteral carcinoma treated with NAC and radical nephroureterectomy. Hydronephrosis was classified into five grades based on computed tomography findings. We focused on the differences between the baseline and post-NAC status of ipsilateral hydronephrosis, radiographic tumor response, and blood markers. Down-grading, no change, and up-grading was observed in 10 (31%), 21 (66%), and 1 (3%) patients, respectively. In univariate analysis, locally advanced disease (cT3), severe hydronephrosis (grade 3/4) at baseline, no change/up-grading of hydronephrosis after NAC, and pathological lymphovascular involvement were identified as potential prognostic factors of progression-free and cancer-specific survival after radical nephroureterectomy. Locally advanced disease (cT3) at baseline and no change/up-grading of hydronephrosis by NAC were independently associated with poor progression-free survival. Notably, none of the patients with NAC-induced down-grading of hydronephrosis died of ureteral carcinoma during the follow-up. We reported the prognostic impact of down-grading of ipsilateral hydronephrosis, which could serve as a useful aid or clinical marker for decision-making.