Long-term oncological outcomes of the Agarwal loop ligation technique for management of the distal ureter during laparoscopic radical nephroureterectomy.

To describe the Agarwal loop ligation technique for management of the distal ureter in laparoscopic radical nephroureterectomy (LNRU) for upper tract urothelial carcinoma (UTUC) and report on long-term oncological outcomes.

In the Agarwal loop ligation technique, the distal ureteric stump is controlled using endoscopic Endoloop® or PolyLoop® ligation to ensure en bloc excision of the bladder cuff and prevent spillage of upper tract urine into the perivesical space. A retrospective review of the medical records of 76 patients who underwent the Agarwal loop ligation technique for UTUC at participating centres from July 2004 to December 2017 was performed. Data collected included demographics, peri-operative and long-term oncological outcomes. Survival was calculated using Kaplan Meier survival analyses.

76 patients were included. Median age was 71.5 and median operative time was 4.3 hours. The intramural ureter and bladder cuff were completely excised in all patients. Distal surgical margins were clear in all, with only two patients found to have tumour extending to the circumferential surgical margin. There were no cases of perivesical recurrence or port site metastasis. Five-year bladder, local and contralateral recurrence-free survival was 59.6%, 89.0% and 93.5% respectively. Metastatic free survival at five-years was 73.5%. Five-year overall survival and cancer specific survival rates were 70.3% and 84.7% respectively.

We have described the Agarwal loop ligation technique for management of the distal ureter in LRNU. This technique complies with oncologic principles outlined in the European Association of Urology (EAU) guidelines, which minimizes tumour spillage. Long-term oncological outcomes are satisfactory, with no cases of perivesical recurrence detected in this series.

BJU international. 2020 Dec 11 [Epub ahead of print]

Venetia Hoe, Henry H Yao, Jack Crozier, Abbie Kanagarajah, Grace Florescu, Jamie Kearsley, Philip Dundee, Helen E O'Connell, Nathan Lawrentschuk, Dinesh K Agarwal

Department of Urology, Western Health, Victoria, Australia., Department of Urology, Melbourne Health, Victoria, Australia., University of Melbourne, Victoria, Australia.

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