What is the role of radical nephroureterectomy in renal transitional cell carcinoma treatment?

Updated: Nov 05, 2019
  • Author: Bagi RP Jana, MD, MBA, MHA, FACP; Chief Editor: E Jason Abel, MD  more...
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Answer

Traditional radical surgery for renal UC consists of total nephroureterectomy with excision of a bladder cuff around the ureteral orifice. Otherwise, 30-75% of patients develop tumor recurrence in the ureteral stump or around the ipsilateral ureteral orifice. Transection of the ureter must be avoided because of the high risk of tumor spillage in the retroperitoneum.

Oncologically, laparoscopic or hand-assisted laparoscopic nephroureterectomy is as effective for localized disease as an open technique would be. [27, 28] In general, the laparoscopic approach is accompanied by less blood loss, less pain and discomfort, faster recovery, and shorter hospital stay. Trocar site recurrence is very rare; to date, 3 cases have been reported. [29]

Patients with poorly differentiated tumors or high-stage disease (especially those with microscopic lymph node involvement) may benefit from extensive retroperitoneal lymphadenectomy. However, the benefit is marginal, and appropriate candidates must be chosen carefully.


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