Intermediate-Term Outcomes of Robot-Assisted Laparoscopic Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma

Abstract

BackgroundThe purpose of this study was to evaluate the intermediate-term oncological outcomes after (RAL-NU) for UUT-UC. Patients and MethodsBetween May 2007 and December 2010, 32 patients with UUT-UC underwent RAL-NU. Data were obtained from a prospectively maintained database. ResultsMedian patient age was 66.5 years. Final pathological stage was pathologic stage Ta (pTa) in 12.5% (n = 4) of patients, pT1 in 28.1% (n = 9), pT2 in 18.8% (n = 6), pT3 in 40.6% (n = 13), and pT4 in 0%. High-grade lesions were present in 81.2% (n = 26) of patients and multifocal disease was present in 25.0% (n = 8). Positive surgical margins occurred in 1 patient. Median follow-up was 45.5 months (range, 24-65). At 2 and 5 years, overall survival was 81.3% and 60.9%; cancer-specific survival was 87.3% and 75.8%, and nonurothelial recurrence-free survival was 71.5% and 68.1%, respectively. On univariate analysis, female sex, positive surgical margins, and pathological tumor stage pT2 and higher are associated with reduced recurrence-free survival (P = .035 and .011, respectively). On multivariate analysis, only female sex and pathological stage pT2 or higher were significant factors (P = .020 and .049, respectively). No factors were found to affect cancer-specific survival. ConclusionTo our knowledge, this represents the largest and longest follow-up after RAL-NU to date. Intermediate-term oncological outcomes seem comparable with those of open and laparoscopic nephroureterectomy. We recommend further larger studies with longer follow-up periods to further define the role of RAL-NU in the treatment of UUT-UC.