Journal Article

Outcomes of laparoscopic, robotic and open nephroureterectomy with bladder cuff excision in patients with T3T4 upper urinary tract urothelial carcinoma: a multi-center retrospective study

Chen, Yung-Tai, Hong, Jian-Hua, Chang, Chao-Hsiang, Chen, I-Hsuan Alan, Yeh, Hsin-Chih, Hsueh, Thomas Y., Khun, Yu, Lin, Jen-Tai, Cheong, Ian-Seng, Tsai, Chung-You, Wang, Shian-Shiang, Tai, Ta-Yao, Lee, Hsiang-Ying, Yu, Chih-Chin, Wu, Chia-Chang, Chang, Yi-Huei, Chiu, Allen W., Jiang, Yuan-Hong, Lin, Chang-Min, Huang, Chao-Yuan, Huang, Hsu-Che, Lee, Lo, Shih-Hsiu, Lin, Wei-Yu, Tseng, Jen-Shu, Wu, Shu-Yu, Fang, Jen-Kai, Chung, Shiu-Dong, Weng, Han-Yu

2024

Overview

Background Nephroureterectomy with bladder cuff excision is the standard treatment for high-risk upper urinary tract urothelial carcinoma (UTUC). The role of minimally invasive surgery in treating locally advanced UTUC remains controversial. This study aimed to compare the outcomes of open , laparoscopic , and robotic surgeries for managing locally advanced UTUC. Methods We retrospectively reviewed 705 patients with locally advanced UTUC from multiple institutions throughout Taiwan. Perioperative outcomes and oncological outcomes, such as cancer-specific survival , overall survival , disease-free survival and bladder-free survival , were compared between the open, laparoscopic and robotic groups. Results The minimally invasive group had better overall and cancer-specific survival (CSS) rates. The 2-year CSS rates of the open, laparoscopic and robotic groups were 71%, 83%, and 77% respectively ( p  < 0.001). The robotic group had similar outcomes to the laparoscopic group. ( p  = 0.061, 0.825, 0.341 for OS, CSS, DFS respectively.) More lymph node dissections were performed and more lymph nodes were harvested in the robotic group ( p  = 0.009). Conclusions Our results demonstrated that minimally invasive surgery, including laparoscopic and robotic surgery, for locally advanced UTUC resulted in oncological outcomes that are non-inferior to those of open surgery.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Bladder / Cancer / Carcinoma / Carcinoma, Transitional Cell - mortality / Carcinoma, Transitional Cell - surgery / Care and treatment / Chemotherapy / Development and progression / Dissection / Female / Humans / Internal Medicine / Kidney Neoplasms - mortality / Kidney Neoplasms - surgery / Laparoscopic surgery / Laparoscopy / Laparoscopy - methods / Lymph nodes / Lymphatic system / Male / Medicine / Medicine & Public Health / Metastasis / Middle Aged / Minimally invasive surgery / Neoplasm Staging / Nephroureterectomy - methods / Patient outcomes / Patients / Retrospective Studies / Robotic surgery / Robotic Surgical Procedures - methods / Survival / Treatment Outcome / Tumors / Upper tract urothelial carcinoma / Ureteral Neoplasms - mortality / Ureteral Neoplasms - surgery / Urinary Bladder - surgery / Urinary tract / Urogenital system / Urological cancer / Urology / Urothelial carcinoma