Abstract Objective To assess the long-term oncologic efficacy of laparoscopic radical nephroureterectomy (RNU). Methods Between August 1993 and May 2001, 39 patients underwent laparoscopic RNU for upper tract transitional cell carcinoma (TCC) at our institution. The medical records of these patients were retrospectively reviewed. Results Clinical outcomes were available in all 39 patients with an actual follow-up ranging from 60 to 148 mo (median: 74). During this time 27 patients (69%) developed at least one TCC recurrence. Eighteen patients had urothelial recurrences, and 9 patients had nonurothelial recurrences. Of these latter patients, 2 patients (5%) had local recurrences. No patient developed a port site metastasis. Eleven patients ultimately had disease progression and died from TCC 7–59 mo (median: 31) after the operation. On statistical analysis, tumor stage was the only factor significantly associated with death from the disease, and tumor location (ureter) was the only factor significantly associated with disease recurrence. Conclusions The long-term overall and disease-specific survival rates after laparoscopic RNU for upper tract TCC are well within the range of results reported after open surgery. Thus, the results of the present study support the continued development of laparoscopic techniques in the management of this aggressive disease.