Abstract
BackgroundTo compare the oncological and perioperative outcomes of different nephroureterectomy approaches in patients with non-metastatic upper tract urothelial carcinoma (UTUC).MethodsWe retrospectively analyzed the data of 422 patients who underwent open, laparoscopic, or robotic nephroureterectomy for non-metastatic UTUC. Perioperative and postoperative survival outcomes were compared using Kaplan-Meier analyses and Cox-proportional hazard models.ResultsOf the patients, 161, 137, and 124 were treated with an open, laparoscopic, and robotic approach, respectively. Laparoscopic and robotic approaches involved significantly less blood loss (p = 0.001), shorter hospital stay (p < 0.001), and longer operation time (p < 0.001) compared with the open approach. There were no significant differences in intraoperative complications (open, 8.1%; laparoscopic, 5.1%; robotic, 7.3%; p = 0.363) or early postoperative complications (open, 14.9%; laparoscopic, 14.6%; robotic, 13.7%; p = 0.880). The laparoscopic and robotic groups showed significantly less postoperative analgesic use (p = 0.015). The robotic group showed significantly longer progression-free, cancer-specific, and overall survivals than the open approach group on univariate Kaplan-Meier analysis, but surgery type was not significantly associated with survival outcomes per multivariate Cox proportional tests (all p-values > 0.05).ConclusionThe laparoscopic and robotic approaches yielded better perioperative outcomes, such as less intraoperative bleeding, shorter hospital stays, less analgesic usage, and non-inferior oncological outcomes, compared with the open approach. Further prospective studies are needed to compare these surgical techniques.
Highlights
We retrospectively analyzed the data of 422 patients who underwent open, laparoscopic, or robotic nephroureterectomy for non-metastatic Upper tract urothelial cancer (UTUC)
Upper tract urothelial cancer (UTUC) is a relatively uncommon malignancy compared with bladder cancer, which accounts for approximately 5% of all urothelial cell malignancies [1]
After approval (B-1805/466-116) for the study was obtained from the ethical review board of Seoul National Bundang Hospital, we retrospectively analyzed the medical records of 459 patients who underwent surgery for UTUC between September 2004 and June 2017 in a single tertiary center in South Korea
Summary
Upper tract urothelial cancer (UTUC) is a relatively uncommon malignancy compared with bladder cancer, which accounts for approximately 5% of all urothelial cell malignancies [1]. Radical nephroureterectomy with bladder cuff excision is the gold standard treatment for non-metastatic UTUC [5]. During the past couple of decades, minimally invasive surgeries such as laparoscopic and robot-assisted approaches have been widely accepted for treating UTUC. Previous studies showed comparable oncological outcomes and additional advantages of those minimally invasive techniques including less postoperative pain, less intraoperative blood loss, and a shorter recovery time [8,9]. We tried to compare the actual oncological and perioperative outcomes of the three surgical approaches (i.e., open, laparoscopic, robotic) in patients with non-metastatic UTUC. To compare the oncological and perioperative outcomes of different nephroureterectomy approaches in patients with non-metastatic upper tract urothelial carcinoma (UTUC)
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