Upper tract urothelial carcinoma (UTUC) is a highly systemic aggressive disease with a tendency of rapid lymph node invasion and metastasis presenting poor oncologic outcomes. Ureteral localization of tumors leads to hydronephrosis and early invasion of the muscle wall, being categorized as high risk tumors.
A 70 years old female was diagnosed with lower left ureteral urothelial tumor associated with hydronephrosis and paraaortic and iliac enlarged lymph nodes. The disease was stratified as high risk upper tract urothelial carcinoma. Treatment consisted in en bloc radical nephroureterectomy, bladder cuff excision and wide lymph node dissection using a combined robotic and 3D laparoscopic approach.
Surgical challenges are surpassed by the use of minimal invasive approaches that offer precise dissection and tissue manipulation with a fast postoperative recovery and early adjuvant oncologic treatment. Comprehensive and complete lymph node dissection along with precise bladder cuff excision offers improved staging, possibly impacting disease prognosis.
En bloc minimal invasive radical nephroureterectomy, bladder cuff excision and wide lymph node dissection offer improved surgery time and lymph node dissection, better management of distal ureteral and bladder cuff excision, watertight cystorrhaphy and optimal disease staging. The experience of the main surgeon with 3D laparoscopy was used in the hereby case to optimize operatory time for the renal step of the surgery. The gentle and precise movements of the Da Vinci robot allowed an accurate en bloc dissection (pN2, N4+/15) with implications in staging and possibly also in oncologic outcomes.
International journal of surgery case reports. 2022 Mar 01 [Epub ahead of print]
Octavian Sabin Tataru, Eliza Cristina Bujoreanu, Bogdan Ovidiu Coste, Teodor Traian Maghiar, Bogdan Petrut
I.O.S.U.D., George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Targu Mures, Department of Urology, Targu Mures, Romania., Prof. Dr. I. Chiricuta" Institute of Oncology, Department of Urology, Cluj-Napoca, Romania., Pelican "Hospital"- Medicover Group, Department of Urology, Oradea, Romania. Electronic address: ., Pelican "Hospital"- Medicover Group, Department of Urology, Oradea, Romania., Prof. Dr. I. Chiricuta" Institute of Oncology, Department of Urology, Cluj-Napoca, Romania; Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Urology, Cluj-Napoca, Romania; ESUT- EAU section of Uro-Technology Training Group, Romania. Electronic address: .