Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis-Reference-Cited by-同舟云学术

Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis

Published:2023-02-23 Issue:5 Volume:15 Page:1409
ISSN:2072-6694
Container-title:Cancers
language:en
Short-container-title:Cancers

Author:

Grossmann Nico C.¹²³^ORCID,Soria Francesco⁴,Juvet Tristan⁵,Potretzke Aaron M.⁶,Djaladat Hooman⁷,Ghoreifi Alireza⁷^ORCID,Kikuchi Eiji⁸,Mari Andrea⁹^ORCID,Khene Zine-Eddine¹⁰,Fujita Kazutoshi¹¹^ORCID,Raman Jay D.¹²,Breda Alberto¹³,Fontana Matteo¹³^ORCID,Sfakianos John P.¹⁴,Pfail John L.¹⁴,Laukhtina Ekaterina¹¹⁵^ORCID,Rajwa Pawel¹¹⁶,Pallauf Maximillian¹¹⁷¹⁸,Poyet Cédric²,Cacciamani Giovanni E.¹⁹^ORCID,van Doeveren Thomas²⁰,Boormans Joost L.²⁰^ORCID,Antonelli Alessandro²¹^ORCID,Jamil Marcus²²,Abdollah Firas²²^ORCID,Ploussard Guillaume²³^ORCID,Heidenreich Axel¹²⁴,Storz Enno²⁴,Daneshmand Siamak⁷,Boorjian Stephen A.⁶,Rouprêt Morgan²⁵,Rink Michael²⁶,Shariat Shahrokh F.¹¹⁵²⁷²⁸²⁹³⁰³¹^ORCID,Pradere Benjamin¹²³^ORCID

Affiliation:

1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria

2. Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland

3. Department of Urology, Luzerner Kantonsspital, 6004 Lucerne, Switzerland

4. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10124 Turin, Italy

5. Department of Urology, Lions Gate Hospital, North Vancouver, BC V7L 2L7, Canada

6. Department of Urology, Mayo Clinic, Rochester, MN 55902, USA

7. Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA

8. Department of Urology, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan

9. Department of Urology, University of Florence, Careggi Hospital, 50100 Florence, Italy

10. Department of Urology, University of Rennes, 35000 Rennes, France

11. Department of Urology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan

12. Department of Urology, Penn State Health, Hershey, PA 17033, USA

13. Urology Department, Fundació Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain

14. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

15. Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia

16. Department of Urology, Medical University of Silesia, 40-752 Katowice, Poland

17. Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, 5020 Salzburg, Austria

18. Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA

19. USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA 90007, USA

20. Department of Urology, Erasmus MC Cancer Institute, University Medical Center, 3015 GD Rotterdam, The Netherlands

21. Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37126 Verona, Italy

22. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA

23. Department of Urology, UROSUD, La Croix Du Sud Hospital, 31130 Quint-Fonsegrives, France

24. Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, 50937 Cologne, Germany

25. Urology Department, GRC n°5, Predictive Onco-Uro, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France

26. Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany

27. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan

28. Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria

29. Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA

30. Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA

31. Department of Urology, Second Faculty of Medicine, Charles University, 150 06 Prague, Czech Republic

Abstract

Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990–2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien–Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan–Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22–2.28, p = 0.001 and HR 1.73, 95%CI 1.22–2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta −1.1, 95% CI −2.2–0.02, p = 0.047 and beta −6.1, 95% CI −7.2–5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31–0.79, p = 0.003 and OR 0.27, 95% CI 0.16–0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

Link

https://www.mdpi.com/2072-6694/15/5/1409/pdf

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