Editorial Comment

Abstract

The authors provide an intriguing study of 100 patients who underwent laparoscopic (n = 63) or robotic (n = 37) nephroureterectomy with concomitant lymph node dissection for the treatment of upper-tract urothelial carcinoma (UTUC). The primary aim of this retrospective study was to determine the differences in perioperative outcomes and lymph node yield between the two techniques. The authors discovered a significant difference in lymph node yield in favor of the robotic cohort (21 vs 11, P < .0001), whereas operative time (5.1 vs 3.9 hours, P = .0001) and length of hospital stay (5 vs 4 days, P = .0002) were significantly shorter in the laparoscopic cohort. There was a nonsignificant trend toward fewer complications (bleeding requiring a blood transfusion) in favor of the robotic cohort (8% vs 30%). The authors freely acknowledge several confounders (inhomogenous cohorts, penetrance of neoadjuvant chemotherapy, consecutive cohorts that introduce bias secondary to surgeon learning curve) that limit the generalizability of these findings. Although these limitations ultimately prevent us from extrapolating more profound conclusions such as the appropriateness and utility of lymph node dissection in the setting of UTUC or the efficacy of neoadjuvant chemotherapy in the context of presumably localized disease, the results nevertheless assuage some of our concerns regarding use of the robot as a largely extirpative technology.