Totally Retroperitoneal One-Position Approach for Laparoscopic Radical Surgery in Upper Urinary Tract Urothelial Carcinoma: A Clinical Trial Evaluation.

Abstract

Background: The standard of care for upper tract urothelial carcinoma (UTUC) traditionally involved open nephroureterectomy with bladder cuff excision. Despite the adoption of transabdominal laparoscopic one-stage nephroureterectomy to mitigate this, the persistently high rate of postoperative intestinal obstruction remains a clinical challenge. This study introduces an innovative approach: a single-position, completely retroperitoneal laparoscopic nephroureterectomy coupled with a 75-45-degree positional change for bladder cuff resection in the treatment of UTUC. The study further evaluates the clinical efficacy of this novel surgical technique.

Methods: A retrospective analysis was conducted on 125 patients diagnosed with UTUC who underwent radical nephroureterectomy at our institution between May 2018 and December 2023. The experimental cohort comprised 65 individuals who received total retroperitoneal one-position laparoscopic nephroureterectomy (TROLN), complete with total intracorporeal bladder cuffing and distal ureterectomy. In contrast, the control cohort included 60 patients who had laparoscopic nephrectomy with a lower abdominal oblique incision for bladder sleeve resection. The study evaluated various perioperative metrics, such as operative duration, blood loss during surgery, incision size, resumption of oral intake postoperatively, drainage tube removal timeline, hospital stay duration, Visual Analogue Scale (VAS) for pain assessment, and complication incidence. In addition, pathological and oncological outcomes were scrutinized.

Results: The TROLN group exhibited pronounced benefits across various surgical outcomes, including reduced operative duration, minimized intraoperative blood loss, shorter incision lengths, lower postoperative pain assessments, expedited return to oral nutrition, swifter drain extraction, and a condensed overall hospitalization period (all P < 0. 05). However, the oncological outcomes showed no significant differences between the TROLN group and the control group.

Conclusion: Drawing from our clinical insights, TROLN is a safe and effective modified technique that offers advantages over traditional laparoscopic combined with open surgery for treating UTUC, including reduced invasiveness, less bleeding, fewer complications, and shorter hospital stays. However, additional prospective studies are imperative to validate these observations.