LAUSR

OBJECTIVES To investigate the recurrence patterns and atypical oncologic failures (AOF) defined as the presence of atypical recurrences, such as retroperitoneal carcinomatosis or port-site recurrence, after laparoscopic radical nephroureterectomy (LRNU) for upper tract urothelial carcinoma (UTUC). METHODS This retrospective study included LRNU cases performed at three institutions. The primary endpoints were the first recurrence site and recurrence-free survival. The recurrence sites were classified as atypical, distant, local, or intravesical. Kaplan-Meier curves were obtained to elucidate the time until recurrence and survival. RESULTS The final analysis included 283 patients. Pathology findings indicated T3 or higher in 112 (40%) patients. The median follow-up period was 31 months, and the 3-year recurrence-free, cancer-specific, and overall survival rates were 69.6%, 78.1%, and 72.0%, respectively. The first recurrence sites were distant, local, atypical, and intravesical in 51 (18%), 36 (13%), 14 (5%), and 94 (33%) patients, respectively. Of the 14 patients with AOF, 12 had pathologically locally advanced tumors, but seven patients had a preoperative diagnosis of clinical stage T2 or less. CONCLUSION A small number of AOF cases were found after LRNU for patients with UTUC. Careful patient selection is critical for AOF prevention.