Transperitoneal radical nephroureterectomy is associated with worse disease progression than retroperitoneal radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Hyun Hwan Sung,Hwang Gyun Jeon,Yoon Seok Suh,Byong Chang Jeong,Seong Soo Jeon,Seong Il Seo,Hyun Moo Lee,Han Yong Choi,Tae Heon Kim

doi:10.1038/s41598-019-42739-0

Abstract

This study aimed to compare the oncologic outcomes between retroperitoneal radical nephroureterectomy (rRNU) and transperitoneal radical nephroureterectomy (tRNU) for the treatment of patients with upper urinary tract urothelial carcinoma (UTUC). Medical records of 743 eligible patients who underwent rRNU or tRNU between 1995 and 2015 were reviewed retrospectively. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were compared according to the surgical approach using the Kaplan–Meier method. Predictors of PFS, CSS, and OS were analyzed with a multivariable Cox regression model. Overall, 620 (83.4%) and 123 (16.6%) patients were treated with rRNU and tRNU, respectively. Five-year CSS and OS rates were equivalent between rRNU and tRNU groups, but 5-year PFS was lower in the tRNU group than the rRNU group (P = 0.005). When patients were stratified by pathological T stage, PFS was significantly different between the two groups in favor of the rRNU group for both organ-confined disease (pTis/pTa/pT1/T2) (P = 0.022) and locally advanced disease (pT3/pT4) (P = 0.039). However, no significant differences in CSS or OS was observed when comparing the two surgical types in patients with organ-confined disease (P = 0.336 and P = 0.851) or patients with locally advanced disease (P = 0.499 and P = 0.278). tRNU was a significant predictor of PFS (hazard ratio = 1.54; P = 0.023), but not CSS or OS. Our findings indicate that the rRNU approach resulted in better PFS than the tRNU approach in patients with UTUC.

Highlights

The prevalence of upper urinary tract urothelial carcinoma (UTUC) has increased gradually, it remains a rare disease that accounts for 5–10% of all urothelial carcinomas[1]
There was no significant difference between the two groups with regard to age, sex, body mass index, American Society of Anesthesiologists score, location of tumor, tumor multifocality, pathological T stage, tumor grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status, or surgical margin status
Our study demonstrated that 5-year cancer-specific survival (CSS) and overall survival (OS) rates were equivalent between the retroperitoneal radical nephroureterectomy (rRNU) and transperitoneal radical nephroureterectomy (tRNU) groups, but that 5-year Progression-free survival (PFS) was lower in the tRNU group than the rRNU group (Fig. 1)

Summary

Introduction

The prevalence of upper urinary tract urothelial carcinoma (UTUC) has increased gradually, it remains a rare disease that accounts for 5–10% of all urothelial carcinomas[1]. Technology, and instruments have enabled less invasive laparoscopic RNU, which is increasingly being performed as a minimally invasive approach[4,5,6]. Both open and laparoscopic RNU can be performed via transperitoneal or retroperitoneal approaches, and each one has its own advantages and limitations. No definitive conclusions regarding the oncologic outcomes of the two different surgical approaches have been reached to date To clarify this issue, we evaluated and compared oncologic outcomes between transperitoneal and retroperitoneal approaches in patients who underwent RNU for UTUC

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Conclusion