Advances in robotic surgery led to the increasing use of this approach to treat UUTC, with several retrospective studies showing promising results. Since all previous studies referred to retrospective data collection, we performed this prospective study in order to compare robotic technique with open approach for patients with UUTC. We collected data prospectively from consecutive patients who were treated for UUTC with either open approach or robotic technique.
Patient data were derived from two centers, one for open approach in Greece and one for robotic approach in Turkey. All patients were treated by surgeons with adequate exposure and experience to the method used at each center in order to avoid bias. In total, 45 patients were included with 29 patients treated with open surgery and 16 with robotic technique. No significant differences were detected on baseline patient characteristics (age, BMI, tumor size and laterality, tumor location, ASA score, and preoperative creatinine or hematocrit). Operative time required for open surgery was significantly shorter (124.37 vs 186.25 min), removal of Foley catheter was significantly shorter in robotic approach (11.43 vs 3.37 days), drain removal time was significantly less in robotic approach (4.5 vs 3.3 days), length of stay was significantly less in robotic approach (5.75 vs 4.3 days), estimated blood loss was significantly less in robotic approach (316.87 vs 137.5 ml and positive surgical margin rate were also significantly less in robotic technique (27.6% vs 0%). No differences were detected regarding bladder recurrence rate during 1 year of follow-up and the rate of complications between the two groups.
The findings of this study suggest that robotic radical nephroureterectomy remains an effective and viable alternative to open approach in patients without metastases at the time of initial diagnosis.
Written by: Lazaros Tzelves, 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
References:
- Mullen E, Ahmed K, Challacombe B. Systematic review of open versus laparoscopic versus robot-assisted nephroureterectomy. RevUrol. 2017; 19:32-43.
- Lee H, Kim HJ, Lee SE, et al. Comparison of oncological and peri-operative outcomes of open, laparoscopic, and robotic nephroureterec-tomy approaches in patients with non-metastatic upper-tract urothelialcarcinoma. PLoS One. 2019; 14:e0210401.
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