Recent advancements in robotic technology, including the introduction and refinement of new platforms, demand a re-evaluation of the surgical techniques used in RNU. In this scenario, while there is extensive data on open and laparoscopic approaches, the evidence on RNU remains limited and somewhat controversial, particularly in the treatment of advanced disease. The study showed promising oncologic results though, with PFS and RFS rates after RNU of 93.7% and 85.9%, respectively, at a median follow-up of 15 months.
A central focus of the research was the management of the bladder cuff during RNU, which is a crucial factor in reducing bladder recurrence. Although bladder cuff excision during RNU is increasingly common, there is still no consensus on the best surgical approach (robotic vs. open) or technique. Interim analysis indicated that over 65% of bladder cuff excisions in the study cohort were performed robotically, which marks a meaningful shift in practice.
Lymph node involvement is another important prognostic factor in UTUC, although the extent and template of lymph node dissection during RNU remain debated. This study aimed to further investigate also the most common lymph node dissection strategies employed based on tumor location, hoping to provide stronger evidence for future practice. Overall, nearly 45% of patients received contemporary lymph node dissection at the time of RNU. Nonetheless, preliminary data confirmed that significant variability exists across centres in the lymph node templates used during RNU.
The figure below focuses on the most common lymph node stations removed according to the side and location of the primary disease.
In summary, we believe this research represents a significant contribution to the ongoing discussion about the role of robotics in UTUC treatment. It identifies critical areas of uncertainty, such as bladder cuff management, the role of lymph node dissection, and the use of different robotic platforms. The multicenter approach and focus on new robotic technologies, including comparisons of emerging platforms, demonstrate the commitment to addressing these questions. By doing so, the study aims to push the boundaries of UTUC care and improve oncologic outcomes for patients.
Written by: Fabrizio Di Maida, MD, FEBU, Urologist, Member, EAU Young Academic Urologists (YAU) Robotic Surgery Working Group, Unit of Oncologic Minimally-Invasive Urology and Andrology, AOU Careggi; PhD Candidate, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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