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.

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.

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.

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).

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.

BMC urology. 2024 Oct 21*** epublish ***

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

Department of Urology, China Medical University Hospital, China Medical university, Taichung, Taiwan., Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan., Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan., Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan., Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan., Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan., Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Department of Urology, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan., Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan., Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, 600, Taiwan., Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, 23148, Taiwan., Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan., Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan., Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan., Department of Urology, China Medical University Hospital, China Medical university, Taichung, Taiwan. .