Email Alert | RSS

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

Previous Articles     Next Articles

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

RICH HTML

   

PDF (PC)

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
[1] Siegel RL, Miller KD, Jemal A . Cancer Statistics, 2017[J]. CA Cancer J Clin, 2017,67(1):7-30.
[2] Munoz JJ, Ellison LM . Upper tract urothelial neoplasms: incidence and survival during the last 2 decades[J]. J Urol, 2000,164(5):1523-1525.
[3] Rouprêt M, Babjuk M, Compérat E , et al. European Association of Urology Guidelines on upper urinary tract urothelial cell carcinoma: 2015 update[J]. Eur Urol, 2015,68(5):868-879.
[4] Kaag MG , O’Malley RL, O’Malley P, et al. Changes in renal function following nephroureterectomy may affect the use of peri-operative chemotherapy[J]. Eur Urol, 2010,58(4):581-587.
[5] Gadzinski AJ, Roberts WW, Faerber GJ , et al. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma[J]. J Urol, 2010,183(6):2148-2153.
[6] Verduyckt FJ, Heesakkers JP, Debruyne FM . Long-term results of ileum interposition for ureteral obstruction[J]. Eur Urol, 2002,42(2):181-187.
[7] Hardy JD . High ureteral injuries. Management by autotransplantation of the kidney[J]. JAMA, 1963,184(1):97-101.
[8] Murphy GP, Staubitz WJ, Kenny GM . Renal autotransplantation for rehabilitation of a patient with multiple urinary tumors[J]. J Urol, 1972,107(2):199-202.
[9] Pettersson S, Brynger H, Henriksson C , et al. Treatment of urothelial tumors of the upper urinary tract by nephrouretherectomy, renal autotransplantation, and pyelocystostomy[J]. Cancer, 1984,54(3):379-386.
[10] Holmang S, Johansson SL . Tumours of the ureter and renal pelvis treated with resection and renal autotransplantation: a study with up to 20 years of follow-up[J]. BJU Int, 2005,95(9):1201-1205.
[11] Cheng YT, Flechner SM, Chiang PH . The role of laparoscopy-assisted renal autotransplantation in the treatment of primary ureteral tumor[J]. Ann Surg Oncol, 2014,21(11):3691-3697.
[12] Pettersson S, Brynger H, Johansson S , et al. Extracorporeal surgery and autotransplantation for carcinoma of the pelvis and ureter[J]. Scand J Urol Nephrol, 1979,13(1):89-93.
[13] Gill IS, Uzzo RG, Hobart MG , et al. Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation[J]. J Urol, 2000,164(5):1500-1504.
[14] Jarrett TW, Potter SR, Girrotto JA , et al. Laparoscopic assisted autotransplantation for treatment of transitional cell carcinoma of the mid ureter[J]. J Urol, 2001,165(5):1625-1626.
[15] Kang CH, Yu TJ, Hsieh HH , et al. Synchronous bilateral primary transitional cell carcinoma of the upper urinary tracts: ten patients with more than five years of follow-up[J]. Urology, 2004,63(2):380-382.
[16] Iida T, Kawa G, Matsuda T . A case of preserving renal function by renal autotransplantation for bilateral urothelial carcinoma of the ureter[J]. Int J Urol, 2009,16(6):587.
[17] Bourgi A, Aoun R, Ayoub E , et al. Experience with renal autotransplantation: typical and atypical indications [J/OL]. Adv Urol, ( 2018 -03-26) [2019-01-05].
[18] Kortram K, Ijzermans JN, Dor FJ . Perioperative events and complications in minimally invasive live donor nephrectomy: A systematic review and meta-analysis[J]. Transplantation, 2016,100(11):2264-2275.
[19] Ranch T, Granerus G, Henriksson C , et al. Renal function after autotransplantation with direct pyelocystostomy. Long-term follow-up[J]. Br J Urol, 1989,63(3):233-238.
[20] Steffens J, Humke U, Alloussi S , et al. Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update[J]. BJU Int, 2007,99(5):1020-1023.
[1] Jiale GAO, Zhongtao ZHANG. Current status and future perspectives of precision treatment for locally advanced rectal cancer [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 247-250.
[2] Wen DU, Wenbo ZHANG, Yao YU, Shuo LIU, Huiyu SU, Leihao HU, Zunan TANG, Binzhang WU, Zhen CHEN, Jiaqi LI, Hao WANG, Xin PENG. Exploration and clinical application of the "digital and intelligent surgery" diagnosis and treatment workflow for oral and maxillofacial tumors [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 278-284.
[3] Jingheng WU, Yunhao XUE, Shanlin CHEN, Yintao GUO, Yuntao LIU, Wei ZHANG. Super microsurgical lymphaticovenular anastomosis for limb lymphedema: An outcome analysis based on clinical stage and indocyanine green pattern [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 359-364.
[4] Jiayu LIU, Ning ZHU, Yuchen CHANG, Xianming GAO, Yu ZHANG. Accuracy of dynamic navigation-assisted trephine method for bone harvesting [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 365-371.
[5] Bin LI, Han LIANG. Robotic gastrectomy: Research progress and practical challenges [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 416-422.
[6] Ebrahimi Farin, Zhiqiang FENG, Ebrahimi Faraz, Weihua HAN, Ziyang YU, Kuankuan JIA, Jingang AN. Surgical treatment outcomes of different stages of maxillary medication-related osteonecrosis of the jaw [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 107-114.
[7] Zonghan LI, Yangyue HUANG, Ning LI, Minglei LI, Hongcheng SONG, Weiping ZHANG, Chao LIU. Preliminary application of domestic single-port serpentine arm robotic surgical system in children's pyeloplasty [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 662-665.
[8] Qiming ZHANG, Zebo CHEN, Yu TIAN, Dameng PAN, Lei LIU, Hongxian ZHANG, Lei ZHAO, Shudong ZHANG, Lulin MA, Xiaofei HOU. Experience summary of robot-assisted laparoscopic transplant nephrectomy [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 666-669.
[9] Shihao LIU, Liqing XU, Xinfei LI, Kunlin YANG, Zhaoying LI, Zibo ZHANG, Xiang WANG, Wei-xiao FU, Zhihua LI, Xuesong LI. Evaluation of the feasibility and safety of a Chinese developed modular surgical robotic system for robot-assisted pyeloplasty [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 779-783.
[10] Huanrui WANG, Shicong LAI, Haopu HU, Zehua DING, Tao XU, Hao HU. Efficacy analysis of laparoscopy combined with flexible ureteroscope in the treatment of complex ureteral stricture [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 784-788.
[11] Shuai LIU, Zhuo LIU, Yunhe GUAN, Guoliang WANG, Xiaojun TIAN, Hongxian ZHANG, Lei LIU, Lulin MA, Shudong ZHANG. Robot-assisted laparoscopic inferior vena cava segmental resection for renal tumor with tumor thrombus invading the vascular wall [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 796-802.
[12] Zhao ZHAO, Weiyu ZHANG, Wenbo YANG, Yongjie ZHANG, Xiaopeng ZHANG, Huiying ZHAO, Gang ZHOU, Qiang WANG. Kidney transplantation in low-age, low-weight children: A report of two cases [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 803-807.
[13] Weihao LI, Jing LI, Xuemin ZHANG, Wei LI, Qingle LI, Xiaoming ZHANG. Effect of intraoperative blood salvage autotransfusion on the prognosis of patients after carotid body tumor resection [J]. Journal of Peking University (Health Sciences), 2025, 57(2): 272-276.
[14] Zhenlong LIU, Zhenchen HOU, Xiaoqing HU, Shuang REN, Qinwei GUO, Yan XU, Xi GONG, Yingfang AO. Arthroscopic tissue engineering scaffold repair for cartilage injuries [J]. Journal of Peking University (Health Sciences), 2025, 57(2): 384-387.
[15] Lei YU, Wenbo YANG, Yufan YANG, Qiang WANG. Renal autotransplantation for the treatment of complex renal aneurysm in a child: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(2): 396-399.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd