Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: Outcomes of an international multi-institutional study of 101 patients

Sung Yul Park, Koon Ho Rha, Riccardo Autorino, Ithaar Derweesh, Evangelos Liastikos, Yao Chou Tsai, Ill Young Seo, Ugo Nagele, Aly M. Abdel-Karim, Thomas Herrmann, Deok Hyun Han, Soroush Rais-Bahrami, Seung Wook Lee, Kyu Shik Kim, Paolo Fornara, Panagiotis Kallidonis, Christopher Springer, Salah Élsalmy, Shih Chieh Jeff Chueh, Chen Hsun HoKamol Panumatrassamee, Ryan Kopp, Jens Uwe Stolzenburg, Lee Richstone, Jae Hoon Chung, Tae Young Shin, Francesco Greco, Jihad H. Kaouk

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

Original languageEnglish
Pages (from-to)610-615
Number of pages6
JournalBJU International
Volume112
Issue number5
DOIs
Publication statusPublished - Sep 1 2013
Externally publishedYes

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Urinary Tract
Carcinoma
Recurrence
Length of Stay
Urinary Bladder
Conversion to Open Surgery
Surgical Instruments
Laparoscopy
Body Mass Index
Demography

Keywords

  • laparoendoscopic single-site surgery
  • LESS
  • multi-institutional
  • transitional cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma : Outcomes of an international multi-institutional study of 101 patients. / Park, Sung Yul; Rha, Koon Ho; Autorino, Riccardo; Derweesh, Ithaar; Liastikos, Evangelos; Tsai, Yao Chou; Seo, Ill Young; Nagele, Ugo; Abdel-Karim, Aly M.; Herrmann, Thomas; Han, Deok Hyun; Rais-Bahrami, Soroush; Lee, Seung Wook; Kim, Kyu Shik; Fornara, Paolo; Kallidonis, Panagiotis; Springer, Christopher; Élsalmy, Salah; Chueh, Shih Chieh Jeff; Ho, Chen Hsun; Panumatrassamee, Kamol; Kopp, Ryan; Stolzenburg, Jens Uwe; Richstone, Lee; Chung, Jae Hoon; Shin, Tae Young; Greco, Francesco; Kaouk, Jihad H.

In: BJU International, Vol. 112, No. 5, 01.09.2013, p. 610-615.

Research output: Contribution to journalArticle

Park, SY, Rha, KH, Autorino, R, Derweesh, I, Liastikos, E, Tsai, YC, Seo, IY, Nagele, U, Abdel-Karim, AM, Herrmann, T, Han, DH, Rais-Bahrami, S, Lee, SW, Kim, KS, Fornara, P, Kallidonis, P, Springer, C, Élsalmy, S, Chueh, SCJ, Ho, CH, Panumatrassamee, K, Kopp, R, Stolzenburg, JU, Richstone, L, Chung, JH, Shin, TY, Greco, F & Kaouk, JH 2013, 'Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: Outcomes of an international multi-institutional study of 101 patients', BJU International, vol. 112, no. 5, pp. 610-615. https://doi.org/10.1111/j.1464-410X.2012.11775.x
Park, Sung Yul ; Rha, Koon Ho ; Autorino, Riccardo ; Derweesh, Ithaar ; Liastikos, Evangelos ; Tsai, Yao Chou ; Seo, Ill Young ; Nagele, Ugo ; Abdel-Karim, Aly M. ; Herrmann, Thomas ; Han, Deok Hyun ; Rais-Bahrami, Soroush ; Lee, Seung Wook ; Kim, Kyu Shik ; Fornara, Paolo ; Kallidonis, Panagiotis ; Springer, Christopher ; Élsalmy, Salah ; Chueh, Shih Chieh Jeff ; Ho, Chen Hsun ; Panumatrassamee, Kamol ; Kopp, Ryan ; Stolzenburg, Jens Uwe ; Richstone, Lee ; Chung, Jae Hoon ; Shin, Tae Young ; Greco, Francesco ; Kaouk, Jihad H. / Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma : Outcomes of an international multi-institutional study of 101 patients. In: BJU International. 2013 ; Vol. 112, No. 5. pp. 610-615.
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abstract = "Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7{\%} had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7{\%} of cases. An extra trocar was inserted in 28.7{\%} of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0{\%}). There was no bladder cuff excision in 20.8{\%} of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9{\%}). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0{\%}, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9{\%}) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8{\%} of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.",
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TY - JOUR

T1 - Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma

T2 - Outcomes of an international multi-institutional study of 101 patients

AU - Park, Sung Yul

AU - Rha, Koon Ho

AU - Autorino, Riccardo

AU - Derweesh, Ithaar

AU - Liastikos, Evangelos

AU - Tsai, Yao Chou

AU - Seo, Ill Young

AU - Nagele, Ugo

AU - Abdel-Karim, Aly M.

AU - Herrmann, Thomas

AU - Han, Deok Hyun

AU - Rais-Bahrami, Soroush

AU - Lee, Seung Wook

AU - Kim, Kyu Shik

AU - Fornara, Paolo

AU - Kallidonis, Panagiotis

AU - Springer, Christopher

AU - Élsalmy, Salah

AU - Chueh, Shih Chieh Jeff

AU - Ho, Chen Hsun

AU - Panumatrassamee, Kamol

AU - Kopp, Ryan

AU - Stolzenburg, Jens Uwe

AU - Richstone, Lee

AU - Chung, Jae Hoon

AU - Shin, Tae Young

AU - Greco, Francesco

AU - Kaouk, Jihad H.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

AB - Objective To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. Results The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. Conclusions This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

KW - laparoendoscopic single-site surgery

KW - LESS

KW - multi-institutional

KW - transitional cell carcinoma

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