Laparoscopic Versus Open Nephroureterectomy for the Treatment of Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Cumulative Analysis of Comparative Studies

Ni, Shaobin; Tao, Weiyang; Chen, Qi-Yin; Liu, Lianxin; Jiang, Hongchi; Hu, Hailong; Han, Rong; Wang, Chunyang

doi:10.1016/j.eururo.2012.02.019

Cited by 159 publications

(109 citation statements)

References 45 publications

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“…Our results support other studies which have demonstrated comparable oncological outcomes for LNU and ONU [8,10,11]. While our results were not statistically significant, there was a consistent trend towards worse oncological outcomes in the LNU group.…”

Section: Discussionsupporting

confidence: 53%

“…One small randomised trial (80 patients) demonstrated that LNU was associated with less blood loss and shorter length of hospital stay than ONU [9]. The conclusion of many studies is that there is no significant difference in oncological outcomes: overall survival (OS), progression-free survival (PFS) or cancer-specific survival (CSS) [7,10,11]. Interestingly, while the study by Simone et al [9] was powered to examine differences in length of hospital stay, they found trends towards worse 5-year CSS with LNU than ONU (79.8 vs. 89.9%, p = 0.2) and 5-year metastases-free survival (72.5 vs. 77.4%, p = 0.12).…”

Section: Introductionmentioning

confidence: 99%

“…LNU has tended to be undertaken in patients with more favourable pathological stages and a more favourable primary tumour locus (more likely to be tumour of renal pelvis than ureter) [11,12]. Advanced tumour stage and grade are established strong negative prognostic factors on multivariate analysis [13] and the more favourable selection bias in LNU patients has precluded any definitive statements on oncological equivalency between the two treatments to date.…”

Section: Introductionmentioning

confidence: 99%

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Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma

Blackmur¹,

Stewart²,

Egong³

et al. 2014

Urol Int

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Objective: Laparoscopic nephroureterectomy (LNU) offers a superior morbidity profile compared with open nephroureterectomy (ONU) in treating upper urinary tract urothelial cell carcinoma. Evidence of oncological equivalence between LNU and ONU is limited. We compare operative and oncological outcomes for LNU and ONU using matched-pair analysis. Methods: Of 159 patients who underwent a nephroureterectomy at a single institution between April 1992 and April 2010, 13 pairs of ONU and LNU patients were matched for gender, age, tumour location, tumour grade and stage. Operative details, post-operative characteristics and recurrences were collated and survival rates analysed using the Kaplan-Meier method. Results: There was no significant difference in mean operation time between LNU (191 min) and ONU (194 min, p = 0.92). There was no significant difference in the 5-year survival rate between LNU and ONU (overall survival 59.1% vs. 73.5%, p = 0.18; progression-free survival 24.0% vs. 56.0%, p = 0.14; cancer-specific survival 60.9% vs. 73.5%, p = 0.56; bladder cancer recurrence-free survival 8.7% vs. 0.0%, p = 0.09). Conclusion: Amidst limited RCT and comparative studies, this study presents further evidence of oncological equivalence between LNU and ONU. There was a trend towards poorer outcomes following LNU though, which merits further study.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma

Blackmur¹,

Stewart²,

Egong³

et al. 2014

Urol Int

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“…With the evolution of laparoscopic and robotic surgery, minimally invasive variants of RNU have been developed. Thus far, short to mid term oncologic outcomes seem to be equivalent between laparoscopic and open techniques; however, we currently lack the follow up to prove long term oncologic equivalence between these modalities [26] . Management of the ipsilateral intramural ureter is critical for adequate recurrence free survival (RFS), as this is the area of highest recurrence.…”

Section: Rnumentioning

confidence: 99%

Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management

Fiuk¹,

Schwartz²

2016

WJN

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Upper tract urothelial carcinoma (UTUC) is relatively rare compared to urothelial carcinoma of the lower tract, comprising only 5%-10% of all urothelial cancers. Although both entities share histologic properties, UTUC tends to be more invasive at diagnosis and portend a worse prognosis, with a 5 year overall mortality of 23%. To date, the gold standard management of UTUC has been radical nephroureterectomy (RNU), with nephron sparing techniques reserved for solitary kidneys or cases where the patient could not tolerate radical surgery. Limited data from these series, as well as select series where nephron-sparing endoscopic management has been offered to a broader patient base, suggest that minimally invasive, nephron sparing techniques can offer comparable oncologic and survival outcomes to RNU in appropriately selected patients. We review the current literature on the topic and discuss long term outcomes and sequelae of the gold standard treatment, RNU. We also discuss the oncologic outcomes of minimally invasive, endoscopic management of UTUC. Our goal is to provide the reader a comprehensive overview of the current state of the field in order to inform and guide their treatment decisions. Core tip: In the appropriate patient population, minimally invasive endoscopic treatment of upper tract urothelial carcinoma provides comparable oncologic and survival outcomes to the gold standard radical nephroureterectomy.

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“…Traditionally, RNU has been performed using the open surgical approach through a large flank incision, which is associated with substantial pain and morbidity. Since first being documented by Clayman et al in 1991 [3], laparoscopic radical nephroureterectomy (LNU) has gained increasing worldwide acceptance because of its benefits in terms of lower blood loss, quicker patient recovery, less perioperative morbidity and comparable oncological outcomes [4][5][6][7].…”

mentioning

confidence: 99%

Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes

et al. 2016

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Laparoscopic Versus Open Nephroureterectomy for the Treatment of Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Cumulative Analysis of Comparative Studies

Cited by 159 publications

References 45 publications

Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma

Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma

Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management

Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes

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