Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases

Capitanio, Umberto; Shariat, Shahrokh F.; Isbarn, Hendrik; Weizer, Alon Z.; Remzi, Mesut; Roscigno, Marco; Kikuchi, Eiji; Raman, Jay D.; Bolenz, Christian; Bensalah, Karim; Koppie, Theresa M.; Kassouf, Wassim; Fernández, Mario; Ströbel, Philipp; Wheat, Jeffrey; Zigeuner, Richard; Langner, Cord; Waldert, Matthias; Oya, Mototsugu; Guo, Charles C.; Ng, Casey K.; Montorsi, Francesco; Wood, Christopher G.; Margulis, Vitaly; Karakiewicz, Pierre I.

doi:10.1016/j.eururo.2009.03.072

Cited by 162 publications

(96 citation statements)

References 25 publications

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“…20 Capitanio and colleagues carried out a retrospective multicenter study, which included 1249 patients who underwent nephroureterectomy with bladder cuff excision. 21 At follow-up, no statistically significant differences were observed for the recurrence rate or cancer-specific mortality between the two groups. Another retrospective study of 324 consecutive patients treated with radical nephroureterectomy found no evidence to indicate that oncologic control was differentially compromised in patients treated with laparoscopic surgery as compared to those treated with open surgery.…”

Section: Discussionmentioning

confidence: 97%

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Wang¹,

Jiang²,

Chen³

et al. 2013

CUAJ

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Objective: We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Methods: Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. Results: The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3-57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrencefree survival. Conclusion:The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy.

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Section: Discussionmentioning

confidence: 97%

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Wang¹,

Jiang²,

Chen³

et al. 2013

CUAJ

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“…[1] Current incidence is around 0.6 -1/100,000 person-years. Over the last few decades, radical nephroureterectomy (open/laparoscopic) has emerged as standard of care for upper tract urothelial cancer (UTUC) especially for muscle invasive and/or high-grade disease [2]. Primary tumour classification, pathologic grade, lymph node status, multifocality and tumour location have all been implicated as significant prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

Follow-Up Upper Tract Imaging Post-Nephroureterectomy for TCC: Need for a Protocol Driven Approach?

Banerjee¹

2013

OJU

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Objectives : We present a retrospective analysis of follow-up strategy adapted by different clinician in managing UTUC cases. Methods: Case notes of 83 patients undergoing nephroureterectomy for UTUC at our institute were selected. Their follow-up pattern and any imaging protocols for upper tract surveillance were studied retrospectively. Results: Our study highlighted diversity in clinicians' overall approach at a time when no approved guidelines or standardised protocols were available. Conclusions: This study clearly highlighted the need for a protocol driven approach; which has lately been addressed with the introduction of EAU guidelines on this subject matter and majority of practising Urologists will adhere to it.

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“…It would appear from multiple retrospective series, for example, that laparoscopic nephroureterectomy is equivalent to open nephroureterectomy, but this has not been evaluated prospectively. [4][5][6][7] The most recent EAU guidelines state that there is limited data for laparoscopic versus open nephroureterectomy (grade B evidence), lymphadenectomy (Grade C evidence), and technique of bladder cuff excision (Grade C evidence). Other critical questions, such as the use of perioperative chemotherapy, have even less evidence.…”

Section: Introductionmentioning

confidence: 99%

Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada

Melcalfe

Kassouf

Rendon

et al. 2012

CUAJ

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Introduction: We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes. Methods: A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes. Results: There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43). Conclusion: There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.

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Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases

Cited by 162 publications

References 25 publications

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Follow-Up Upper Tract Imaging Post-Nephroureterectomy for TCC: Need for a Protocol Driven Approach?

Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada

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