Laparoscopic Retroperitoneal Nephroureterectomy is a Safe and Adherent Modality for Obese Patients with Upper Urinary Tract Urothelial Carcinoma

Abstract

<br/><b>Objective</b>: We evaluated the association of body mass index (BMI) with perioperative outcomes in patientswho underwent laparoscopic or open radical nephroureterectomy. Materials and <br/><b>Methods</b>: This retrospectivesingle-center study included 113 patients who had been diagnosed with upper urinary tract cancer fromJanuary 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or opennephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitonealapproach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group(<25) and a high-BMI group (BMI≥25). The high-BMI group included 27 patients: 13 in the Lap group and14 in the Open group. <br/><b>Results</b>: Estimated blood loss (EBL) in the Lap group was much lower than that in theOpen group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patientsin the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative timebetween the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of thedata for all the cohorts revealed that the open procedure was a significant risk factor for high EBL (p<0.0001,hazard ratio 8.02). Normal BMI was an independent predictor for low EBL (p=0.01, hazard ratio 0.25). Therewas no significant risk factor for operative time in multivariate analysis. There were no differences in bloodtransfusion rates or adverse event rates between the two surgical groups. <br/><b>Conclusions</b>: Laparoscopic radicalnephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBLeven in obese patients with upper urinary tract cancer.