To analyse surgical, functional, and mid-term oncological outcomes of robot-assisted nephroureterectomy (RANU) in a contemporary large multi-institutional setting.
Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2. 0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time-to-event outcomes were: recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, with a 3-year cut-off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome.
A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of -13.1 (-27.5 to 0) mL/min/1.73 m2 from baseline was observed. The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder-cuff excision, high-grade tumour, pathological T stage ≥3, and nodal involvement.
The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid-term oncological outcomes, mirroring those of open NU, even in non-organ-confined disease.
BJU international. 2024 Sep 12 [Epub ahead of print]
Francesco Ditonno, Antonio Franco, Zhenjie Wu, Linhui Wang, Firas Abdollah, Giuseppe Simone, Andres F Correa, Matteo Ferro, Sisto Perdonà, Daniele Amparore, Raj Bhanvadia, Stephan Brönimann, Dhruv Puri, Dinno F Mendiola, Reuben Ben-David, Sol C Moon, Courtney Yong, Farshad S Moghaddam, Alireza Ghoreifi, Eugenio Bologna, Leslie Claire Licari, Marco Finati, Gabriele Tuderti, Emma Helstrom, Marco Tozzi, Antonio Tufano, Soroush Rais-Bahrami, Chandru P Sundaram, Reza Mehrazin, Mark L Gonzalgo, Ithaar H Derweesh, Francesco Porpiglia, Nirmish Singla, Vitaly Margulis, Alessandro Antonelli, Hooman Djaladat, Riccardo Autorino
Department of Urology, Rush University, Chicago, IL, USA., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy., Istituto Nazionale Tumori di Napoli, IRCCS 'Fondazione G. Pascale', Naples, Italy., Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Urology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA., Department of Urology, Indiana University, Indianapolis, IN, USA., Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, University of Verona, Verona, Italy.