Laparoscopic Radical nephroureterectomy for Upper Renal Excretory Tract urothelial Carcinoma: Results from a single Center in Douala Cameroon

Abstract

Background and aim: Upper Tract Urothelial Carcinoma (UTUC) which represent 5-10% of urothelial tumours are tumours that develop in the urothelium of the pyelocalicial cavities or the ureters. The standard surgical treatment is total open radical nephroureterectomy with excision of the bladder collar. The development of minimally invasive surgery, such as laparoscopic surgery and its contribution to the management of renal pathologies has allowed the adaptation of this technique in the treatment of tumours of the upper excretory tracts. We present the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of patients with upper excretory tract tumours treated by laparoscopic nephroureterectomy. Methods: This prospective single-center study included 5 patients with UTUC treated at the Centre medico-chirugical d’urologie in Douala, Cameroon between 2016 and 2021. Results: We included 4 men and 1 woman, with a mean age of 62.4±3.85 years. Four (80%) patients had a history of tobacco and 3(60%) had a history of repeated urinary tract infections. The main reasons for consultation were gross haematuria and renal colic-type lumbar pain. In all cases, the diagnosis was made by the triad of thoracic and abdominal CT scan, cystoscopy and semi-rigid ureteroscopy. Four (80%) patients had tumours in the ureter and 3(60%) patients had an associated bladder tumour. The treatment consisted of transperitoneal laparoscopic nephroureterectomy with resection of the bladder collar via a double lumbar and iliac approach. The median surgery duration was 300[270-330] minutes and there were no major immediate post-operative complications. Histopathology confirmed that all 5 cases were urothelia carcinomas. Recurrence was observed in 4(80%) patients and 3(60%) patients died from disease progression, with a median survival time of 17.93 months. Conclusion: Laparoscopic total nephroureterectomy with resection of the bladder collar is an important alternative to open surgery in the treatment of tumours of the upper excretory tract as it reduces operating time, length of hospital stay, and the occurrence of complications. The prognosis of these tumours depends on the stage and grade with a significant potential for recurrence indicating the need for regular and prolonged monitoring.