Skip to main content

Advertisement

SpringerLink
Log in

The Role of Laparoscopy-assisted Renal Autotransplantation in the Treatment of Primary Ureteral Tumor

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To evaluate the effect and safety of laparoscopy-assisted renal autotransplantation treatment for primary ureteral cancer (PUC).

Methods

Medical records of patients undergoing hand-assisted retroperitoneoscopic nephroureterectomy–extracorporeal total ureterectomy–renal autotransplantation–pyelocystostomy (Lap AutoTx) were analyzed. Demographic, intraoperative, and postoperative data were assessed.

Results

Fifteen patients diagnosed with PUC underwent this novel approach. Three kidneys were abandoned owing to the detection of residual cancer on the renal pelvic junction, surgeon’s judgment on three severe atherosclerotic arteries, and palpable pelvic lymph nodes proven to be evidence of metastatic disease by frozen section analysis. Twelve patients (mean ± SD age 67.5 ± 7.5 years) were treated with Lap AutoTx for PUC successfully. No perioperative mortality occurred. One patient with solitary kidney experienced delayed graft function that required short-term hemodialysis. Three recurrent superficial diseases in three patients were treated with transurethral resection. The mean ± SD follow-up duration was 12.1 ± 6.7 months (range 3–24 months). The renal pelvicaliceal system was easily examined by flexible cystoscopy.

Conclusions

Lap AutoTx is less invasive compared with the traditional two-incisional manner and can be performed safely even among elderly patients. Compared with other currently used therapies, this novel treatment can be used to successfully treat PUC with the added advantages of total resection of the ureteral lesion, preservation of the renal function, and simplification of follow-up procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ouzzane A, Colin P, Xylinas E, et al. Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol. 2011;60:1258–65.

    Article  PubMed  Google Scholar 

  2. Yang MH, Chen KK, Yen CC, et al. Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology. 2002;59:681–7.

    Article  PubMed  Google Scholar 

  3. Kang CH, Yu TJ, Hsieh HH, et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer. 2003;98:1620–6.

    Article  PubMed  Google Scholar 

  4. Raymundo EM, Lipkin ME, Banez LB, et al. Third prize: the role of endoscopic nephron-sparing surgery in the management of upper tract urothelial carcinoma. J Endourol. 2011;25:377–84.

    Article  PubMed  Google Scholar 

  5. Lane BR, Smith AK, Larson BT, et al. Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer. 2010;116:2967–73.

    Article  PubMed  Google Scholar 

  6. Kaag MG, O’Malley RL, O’Malley P, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol. 2010;58:581–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pettersson S, Brynger H, Henriksson C, Johansson SL, Nilson AE, Ranch T. Treatment of urothelial tumors of the upper urinary tract by nephroureterectomy, renal autotransplantation, and pyelocystostomy. Cancer. 1984;54:379–86.

    Article  CAS  PubMed  Google Scholar 

  8. Holmäng S, Johansson SL. Tumours of the ureter and renal pelvis treated with resection and renal autotransplantation: a study with up to 20 years of follow-up. BJU Int. 2005;95:1201–5.

    Article  PubMed  Google Scholar 

  9. Chiang PH, Luo HL, Chen YT, Kang CH, Chuang YC, Lee WC. Is hand-assisted retroperitoneoscopic nephroureterectomy better than transurethral bladder cuff incision-assisted nephroureterectomy? J Endourol. 2011;25:1307–13.

    Article  PubMed  Google Scholar 

  10. Weight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183:1317–23.

    Article  PubMed  Google Scholar 

  11. Soderdahl DW, Fabrizio MD, Rahman NU, Jarrett TW, Bagley DH. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. 2005;23:114–22.

    Article  PubMed  Google Scholar 

  12. Gadzinski AJ, Roberts WW, Faerber GJ, Wolf JS Jr. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol. 2010;183:2148–53.

    Article  PubMed  Google Scholar 

  13. Scolieri MJ, Paik ML, Brown SL, Resnick MI. Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma. Urology. 2000;56:930–4.

    Article  CAS  PubMed  Google Scholar 

  14. Smith AK, Stephenson AJ, Lane BR, et al. Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management. Urology. 2011;78:82–6.

    Article  PubMed  Google Scholar 

  15. Silberstein JL, Power NE, Savage C, et al. Renal function and oncologic outcomes of parenchymal sparing ureteral resection versus radical nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2012;187:429–34.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jeldres C, Lughezzani G, Sun M, et al. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010;183:1324–9.

    Article  PubMed  Google Scholar 

  17. Yang WC, Hwang SJ; Taiwan Society of Nephrology. Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance. Nephrol Dial Transplant. 2008;23:3977–82.

    Google Scholar 

  18. Novick AC, Jackson CL, Straffon RA. The role of renal autotransplantation in complex urological reconstruction. J Urol. 1990;143:452–7.

    CAS  PubMed  Google Scholar 

  19. Hardy JD. High ureteral injuries: management by autotransplantation of the kidney. JAMA. 1963;184:97–101.

    Article  CAS  PubMed  Google Scholar 

  20. Flechner SM, Noble M, Tiong HY, Coffman KL, Wee A. Renal autotransplantation and modified pyelovesicostomy for intractable metabolic stone disease. J Urol. 2011;186:1910–5.

    Article  PubMed  Google Scholar 

  21. Steffens J, Humke U, Alloussi S, Ziegler M, Siemer S. Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update. BJU Int. 2007;99:1020–3.

    Article  PubMed  Google Scholar 

  22. Kardar AH, Lindstedt EM, Peracha A, Shaibani K. Renal autotransplantation and pyelocystostomy for the treatment of urothelial tumors of the upper urinary tract. J Urol. 1998;159:195.

    Article  CAS  PubMed  Google Scholar 

  23. Roupret M, Yates DR, Comperat E, Cussenot O. Upper urinary tract urothelial cell carcinomas and other urological malignancies involved in the hereditary nonpolyposis colorectal cancer (lynch syndrome) tumor spectrum. Eur Urol. 2008;54:1226–36.

    Article  PubMed  Google Scholar 

  24. Chen CH, Dickman KG, Moriya M, et al. Aristolochic acid-associated urothelial cancer in Taiwan. Proc Natl Acad Sci USA. 2012;109:8241–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Audenet F, Colin P, Yates DR, et al. A proportion of hereditary upper urinary tract urothelial carcinomas are misclassified as sporadic according to a multi-institutional database analysis: proposal of patient-specific risk identification tool. BJU Int. 2012;110(11 Pt B):E583–9.

    Article  PubMed  Google Scholar 

  26. Hafner C, Knuechel R, Stoehr R, Hartmann A. Clonality of multifocal urothelial carcinomas: 10 years of molecular genetic studies. Int J Cancer. 2002;101:1–6.

    Article  CAS  PubMed  Google Scholar 

  27. Huang A, Low RK, deVere White R. Nephrostomy tract tumor seeding following percutaneous manipulation of a ureteral carcinoma. J Urol. 1995;153(3 Pt 2):1041–2.

    CAS  PubMed  Google Scholar 

  28. Dols LF, Kok NF, Roodnat JI, et al. Living kidney donors: impact of age on long-term safety. Am J Transplant. 2011;11:737–42.

    Article  CAS  PubMed  Google Scholar 

  29. Meng MV, Freise CE, Stoller ML. Expanded experience with laparoscopic nephrectomy and autotransplantation for severe ureteral injury. J Urol. 2003;169:1363–7.

    Article  PubMed  Google Scholar 

  30. Bluebond-Langner R, Rha KH, Pinto PA, et al. Laparoscopic-assisted renal autotransplantation. Urology. 2004;63:853–6.

    Article  PubMed  Google Scholar 

  31. Ranch T, Fall M, Henriksson C, Nilson AE, Pettersson S. Urodynamic consequences of a direct pyelocystostomy at autotransplantation of the kidney. Urol Int. 1985;40:82–7.

    Article  CAS  PubMed  Google Scholar 

  32. Ranch T, Granerus G, Henriksson C, Pettersson S. Renal function after autotransplantation with direct pyelocystostomy: long-term follow-up. Br J Urol. 1989;63:233–8.

    Article  CAS  PubMed  Google Scholar 

  33. Ristau BT, Tomaszewski JJ, Ost MC. Upper tract urothelial carcinoma: current treatment and outcomes. Urology. 2012;79:749–56.

    Article  PubMed  Google Scholar 

  34. Eisenberg ML, Lee KL, Zumrutbas AE, Meng MV, Freise CE, Stoller ML. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation. J Urol. 2008;179:240–3.

    Article  PubMed  Google Scholar 

  35. Klop KW, Dols LF, Kok NF, Weimar W, Ijzermans JN. Attitudes among surgeons towards live-donor nephrectomy: a European update. Transplantation. 2012;94:263–8.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yuan-Tso Cheng MD & Po-Hui Chiang MD, PhD

  2. Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Stuart M. Flechner MD

Authors
  1. Yuan-Tso Cheng MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stuart M. Flechner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Po-Hui Chiang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Po-Hui Chiang MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, YT., Flechner, S.M. & Chiang, PH. The Role of Laparoscopy-assisted Renal Autotransplantation in the Treatment of Primary Ureteral Tumor. Ann Surg Oncol 21, 3691–3697 (2014). https://doi.org/10.1245/s10434-013-3382-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3382-y

Keywords

Search

Navigation