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

  • Matsumoto, Kazumasa (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Hirayama, Takahiro (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Kobayashi, Kentaro (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Hirano, Syuhei (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Nishi, Morihiro (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Ishii, Daisuke (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Tabata, Ken-ichi (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Fujita, Tetsuo (Dept. of Urology, School of Medicine, Kitasato University) ;
  • Iwamura, Masatugu (Dept. of Urology, School of Medicine, Kitasato University)
  • Published : 2015.04.29


Objective: We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy. Materials and Methods: This retrospective single-center study included 113 patients who had been diagnosed with upper urinary tract cancer from January 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or open nephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitoneal approach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group (<25) and a high-BMI group ($BMI{\geq}25$). The high-BMI group included 27 patients: 13 in the Lap group and 14 in the Open group. Results: Estimated blood loss (EBL) in the Lap group was much lower than that in the Open group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patients in the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative time between the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of the data 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). There was no significant risk factor for operative time in multivariate analysis. There were no differences in blood transfusion rates or adverse event rates between the two surgical groups. Conclusions: Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBL even in obese patients with upper urinary tract cancer.


Body mass index;laparoscopy;nephroureterectomy;retroperitoneum;urothelial carcinoma


  1. Capitanio U, Shariat SF, Isbarn H, et al (2009). Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol, 56, 1-9.
  2. Fazeli-Matin S, Gill IS, Hsu TH, et al (1999). Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol, 162, 665-9.
  3. Feder MT, Patel MB, Melman A, et al (2008). Comparison of open and laparoscopic nephrectomy in obese and nonobese patients: outcomes stratified by body mass index. J Urol, 180, 79-83.
  4. Fugita OE, Chan DY, Roberts WW, et al (2004). Laparoscopic radical nephrectomy in obese patients: outcomes and technical considerations. Urology, 63, 247-52.
  5. Hagiwara M, Miyajima A, Matsumoto K, et al (2011). Benefit of laparoscopic radical nephrectomy in patients with a high BMI. Jpn J Clin Oncol, 41, 400-4.
  6. Inoue S, Mita K, Shigeta M, et al (2006). Retroperitoneoscopic radical nephrectomy in obese patients: outcomes and considerations. Urol Int, 76, 252-5.
  7. Jiganti JJ, Goldstein WM, Williams CS (1993). A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res, 289, 175-9.
  8. Kamihira O, Hattori R, Yamaguchi A, et al (2009). Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol, 55, 1397-407.
  9. Kruk J (2014). Overweight, obesity, oxidative stress and the risk of breast cancer. Asian Pac J Cancer Prev, 15, 9579-86.
  10. Makiyama K, Nakaigawa N, Miyoshi Y, et al (2008). Retroperitoneoscopic nephrectomy in overweight and obese Japanese patients: complications and outcomes. Urol Int, 81, 427-30.
  11. Matsumoto K, Ikeda M, Matsumoto T, et al (2014). Serum periplakin as a potential biomarker for urothelial carcinoma of the urinary bladder. Asian Pac J Cancer Prev, 15, 9927-31.
  12. Mendoza D, Newman RC, Albala D, et al (1996). Laparoscopic complications in markedly obese urologic patients (a multiinstitutional review). Urology, 48, 562-7.
  13. Mokdad AH, Ford ES, Bowman BA, et al (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA, 289, 76-9.
  14. Ni S, Tao W, Chen Q, et al (2012). Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol, 61, 1142-53.
  15. Oh CM, Jun JK, Suh M (2014). Risk of cancer mortality according to the metabolic health status and degree of obesity. Asian Pac J Cancer Prev, 15, 10027-31.
  16. Ozbek E, Otunctemur A, Dursun M, et al (2014). Association between the metabolic syndrome and high tumor grade and stage of primary urothelial cell carcinoma of the bladder. Asian Pac J Cancer Prev, 15, 1447-51.
  17. Rapp K, Schroeder J, Klenk J, et al (2005). Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. Br J Cancer, 93, 1062-7.
  18. Reeves GK, Pirie K, Beral V, et al (2007). Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ, 335, 1134.
  19. Walton TJ, Novara G, Matsumoto K, et al (2011). Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int, 108, 406-12.
  20. Wolin KY, Carson K, Colditz GA (2010). Obesity and cancer. Oncologist, 15, 556-65.
  21. Yoshiike N, Seino F, Tajima S, et al (2002). Twenty-year changes in the prevalence of overweight in Japanese adults: the national nutrition survey 1976-95. Obes Rev, 3, 183-90.

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