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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 758-763. doi: 10.19723/j.issn.1671-167X.2019.04.029

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Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment

Si-da CHENG1,Wan-qiang LI2,Li MU3,Guang-pu DING1,Bo ZHANG1,Cheng SHEN1,Ze-wei YING1,Kun-lin YANG1,Han HAO1,Xue-song LI1,△(),Li-qun ZHOU1,△()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People’s Hospital, Yichang 443003, Hubei, China
    3. Central Operating Room, Peking University First Hospital, Beijing 100034, China
  • Received:2019-03-18 Online:2019-08-18 Published:2019-09-03
  • Contact: Xue-song LI,Li-qun ZHOU E-mail:pineneedle@sina.com;zhoulqmail@sina.com

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Abstract:

Objective: To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment. Me-thods: One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient.Results: The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult.Conclusion: The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow-up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it’s been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.

Key words: Urothelial carcinoma, Kidney, Transplantation, autologous, Totally extraperitoneal laparoscopy, Anastomosis, surgical

CLC Number: 

  • R737.13

Figure 1

CT scan demonstrates left hydronephrosis"

Figure 2

CT scan demonstrates a mass with soft tissue density in middle left ureter"

Figure 3

Trocar distribution and Gibson incision"

Figure 4

Key steps of the totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis A, transecting the ureter; B, clamping and transecting the renal vessels; C, hand-assisted retroperitoneoscopic nephrectomy; D, ureterectomy with bladder cuff excision; E, dissecting left external iliac vessels; F, the renal vein was anastomosed end-to-side to the external iliac vein; G, the renal arteries were anastomosed end-to-side to the external iliac artery; H, Boari flap; I, Boari flap-pelvic anastomosis."

Figure 5

Postoperative serum creatinine level"

Figure 6

Direct view of the left pelvis under cystoscope"

Table 1

Published reports of renal autotransplantation for UTUC treatment"

Study Year Case Approach Procedure Follow-up/
months		 Renal function Tumor
recurrence
Pettersson, et al[9] 1984 8 Open Nephroureterectomy,extracorporeal total ureterectomy, renal autotransplantation by Gibson incision and pyelocystostomy 14-53 Normal in 7 cases 3/8
Gill, et al[13] 2000 1 Retroperitoneal
laparoscopy		 Nephroureterectomy,extracorporeal ureterectomy, renal autotransplantation by Gibson incision and pyeloureterostomy 6 Normal 0
Jarrett, et al[14] 2001 1 Transperitoneal
laparoscopy		 Nephrectomy, intracorporeal ureterectomy and renal autotransplan-tation by extraperitoneal incision 6 Normal 0
Kang, et al[15] 2004 1 Open Nephroureterectomy,extracorporeal total ureterectomy,renal autotransplantation by Gibson incision and pyelocystostomy 70 Normal 1/1
Holmang, et al[10] 2005 23 Not reported Not reported 84-240 Not reported 10/23
Iida, et al[16] 2009 1 Retroperitoneal
laparoscopy		 Nephroureterectomy,extracorporeal ureterectomy, renal autotransplantation by Gibson incision and pyeloureterostomy 20 Normal 0
Cheng, et al[11] 2014 12 Retroperitoneal
laparoscopy		 Hand-assisted nephroureterectomy, extracorporeal total ureterectomy, renal autotransplantation by Gibson incision and pyelocystostomy 3-24 Normal 3/12
Bourgi, et al[17] 2018 2 Not reported Not reported 30 (average) Normal 0
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