Abstract
BackgroundMany studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1–4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1–4/N0-X UTUC.MethodsWe collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1–4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox’s proportional hazards model was used for univariate and multivariate analysis.ResultsThe mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46–3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54–1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616–3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81–3.17, P = 0.17).ConclusionsThe results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1–4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.
Highlights
Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC)
LNU can be an alternative to the open procedure for T1–4/N0-X UTUC
The open surgery preferred the presence of previous hydronephrosis, absence of previous bladder urothelial carcinoma, and underwent extravesical management of the distal ureter (P < 0.05 for all) (Table 1)
Summary
Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). The purpose of this study was to compare the oncological outcomes of LNU vs ONU for the treatment in patients with T1–4/N0-X UTUC. One study showed that there was a trend toward an independent association between surgical approach and RFS [13], and three studies showed a higher risk of intravesical RFS with LNU [7, 20, 21] These studies focused on the oncological outcomes among the entire cohort of UTUC patients. The present study aimed to compare intravesical RFS, overall RFS, CSS, and OS between ONU and LNU for localized and/or locally advanced UTUC (T1–4/N0-X), performed in two Chinese tertiary teaching hospitals
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