Is Robotic Superior to Laparoscopic Approach for Radical Nephroureterectomy with Bladder Cuff Excision in Treating Upper Urinary Tract Urothelial Carcinoma?

Background: Laparoscopic nephroureterectomy (LNU) has become popular in treating upper urinary tract urothelial carcinoma (UTUC) and an emerging trend was observed in robotic approaches. Therefore, we compared robotic-assisted radical nephroureterectomy (RANU) and LNU for the treatment of UTUC. Materials and Methods: This observational and retrospective case-series study included UTUC patients who underwent LNU or RANU. A pure laparoscopic approach was adopted in the LNU treatment group, and bladder cuff excision (BCE) was performed mostly with the open approach. Either the da Vinci Si or Xi surgical system was used for RANU. Extravesical BCE was performed, and bladder defects were closed intracorporeally. Perioperative and oncological outcomes were compared between the LNU and RANU groups. Results: A total of 231 patients who underwent RANU (n = 87) or LNU (n = 144) were included. No significant differences were noted between the groups in terms of demographics, tumor characteristics, operative time, catheter time, or complications. Compared with LNU, RANU had a lower intraoperative blood loss (30 vs. 150 mL, p < 0.001) and shorter postoperative hospital stay (8 vs. 9 days, p = 0.009). The five-year overall survival, cancer-specific survival, and bladder recurrence-free survival were comparable between the groups. Conclusion: Compared with LNU, RANU had similar perioperative and oncological outcomes but was superior in terms of intraoperative blood loss and postoperative length of hospital stay. However, considering the potential biases due to the heterogeneity of our cases, the interpretation of the results must be very cautious. .

Journal of endourology. 2022 Oct 20 [Epub ahead of print]

Yu Pin Huang, Eric Yi-Hsiu Huang, Hsiao-Jen Chung, Meng-Che Tai, Tzu-Hao Huang, Tony Tzu-Chun Wei, Yu-Hua Fan, Chih-Chieh Lin, Tzu-Ping Lin, Junne-Yih Kuo, Shing-Hwa Lu, Yen-Hwa Chang, Alex T L Lin, William Js Huang

Taipei Veterans General Hospital, 46615, Urology, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City 112, Taiwan (R.O.C.), Taipei, Taipei, Taiwan, 11217; obinhwang0201@gmail.com., Taipei Veterans General Hospital, Urology, Taipei, Taiwan., Taipei Veterans General Hospital, Division of Urology, Department of Surgery, No. 201, Sec. 2, Shih-pai Road, Taipei, Taipei, Taiwan, 112., Taipei Veterans General Hospital, 46615, Urology, Taipei, Taiwan; cceers@gmail.com., Taipei Veterans General Hospital, 46615, Urology, Taipei, Taiwan; jayhuangx@gmail.com., Taipei Veterans General Hospital, 46615, Taipei, Taiwan; tony720714@gmail.com., Taipei Veterans General Hospital, 46615, No. 201, Sec. 2, Shipai Rd., Taipei, Taiwan, 112; yhfan2@gmail.com., Taipei Veterans General Hospital, 46615, Urology, Taipei, Taiwan; jayslylin@gmail.com., National Yang-Ming University, School of Medicine, Faculty of Medicine, Taipei, Taiwan; tplin63@gmail.com., Taipei Veterans General Hospital, 46615, Urology, Taipei, Taiwan; jykuotpe@gmail.com., Taipei Veterans General Hospital, 46615, Taipei, Taiwan; shlu77777@gmail.com., Taipei Veterans General Hospital, 46615, Taipei, Taiwan; yhchang.gu@gmail.com., National Yang-Ming University, School of Medicine, Faculty of Medicine, 201 Sec 2 Shih Pai road, Taipei, Taiwan, 112., Taipei Veterans General Hospital, 46615, Urology, Taipei, Taiwan.