Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

Abstract

PurposeThis study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy.MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches.ResultsAmong the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001).ConclusionsMinimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.

Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis

“…All 10 of the included studies were retrospective cohort studies 13–22 . Table 1 summarises the methodological characteristics of the included studies.…”

“…All 10 of the included studies were retrospective cohort studies. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Table 1 summarises the methodological characteristics of the included studies. The methodological quality of the included studies was generally good and is presented in Table 2 .…”

“…Tumour location was reported in six of our included studies. 13 , 15 , 16 , 17 , 18 , 22 Out of 3387 cases, 65.3% ( n = 2212) of tumours were located within the kidney, 31.2% ( n = 1056) were within the ureter and the remaining 3.5% ( n = 119) were involved both the kidney and ureter.…”

Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies

“…Although more lymph node dissections were performed in RANU, our results reported similar recurrence rates (OR=0.99, 95%CI: 0.56 to 1.76, P=0.98) as well as 5-year OS rate (OR=1.08, 95%CI: 0.63 to 1.85, P=0.78) between RANU and LNU, suggesting that surgical approach does not alter oncologic outcomes. Noticeably, the overall survival data available for quantitative analysis was only reported by three enrolled studies ( 35 , 38 , 40 ). Hence, we were unable to conduct comprehensive and stable analyses, and this result should be interpreted with caution.…”

Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study

“…In our recently published study, we also discovered different proportions of LND in different minimally invasive NU approaches, and robotassisted NU had the highest LND rate (41.1%). The surgical technique and experience of surgeons also affects the rate of LND (7).…”