[Place of laparoscopic nephroureterectomy in the treatment of upper urinary tract transitional cell carcinoma]

The current reference treatment for upper urinary tract transitional cell carcinoma is open nephroureterectomy via a lumbar incision and an iliac incision with resection of a large bladder cuff: Since the first laparoscopic nephroureterectomy performed in 1991, several teams have studied this approach for the treatment of urinary tract tumours. Laparoscopy has the advantage of decreased morbidity for the patient and allows early return to work. Recent published series do not demonstrate any difference in terms of cancer control between open and laparoscopic nephroureterectomy. However, the follow-up of laparoscopic nephroureterectomy is still limited and the safety of this technique has not been fully demonstrated. It therefore appears preferable to limit the indications for laparoscopic nephroureterectomy to small and/or low-grade tumours to avoid excessive manipulation of large transitional cell carcinomas in a gaseous atmosphere that can predispose to dissemination during dissection. Diagnostic ureteroscopy has therefore become a useful tool in the preoperative assessment. Biopsies can determine the tumour grade and guide the surgeon's choice of surgical approach.