Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study

BMC Surgery, Jan 2017

Background Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T 1–4 /N 0-X ). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T 1–4 /N 0-X UTUC. Methods We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T 1–4 /N 0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox’s proportional hazards model was used for univariate and multivariate analysis. Results The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46–3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54–1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616–3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81–3.17, P = 0.17). Conclusions The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T 1–4 /N 0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.

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Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study

Liu et al. BMC Surgery Laparoscopic versus open nephroureterectomy to treat localized and/ or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study Jian-Ye Liu 0 1 Ying-Bo Dai 0 1 Fang-Jian Zhou Zhi Long 0 1 Yong-Hong Li Dan Xie Bin Liu 0 1 Jin Tang 0 1 Jing Tan 0 1 Kun Yao 0 1 Le-Ye He 0 1 0 Institute of Prostate Disease of Central South University , No.138, Tongzipo Road, Changsha 410013, Hunan , China 1 Department of Urology, The Third Xiangya Hospital of Central South University , No.138, Tongzipo Road, Changsha 410013, Hunan , China Background: Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1-4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1-4/N0-X UTUC. Methods: We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1-4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox's proportional hazards model was used for univariate and multivariate analysis. Results: The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46-3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54-1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616-3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81-3.17, P = 0.17). (Continued on next page) © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. - (Continued from previous page) Conclusions: The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1–4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings. Background Upper urinary tract urothelial carcinoma (UTUC) is a relatively rare malignancy. It is estimated to comprise 10% of all renal tumors and 5% of urothelial carcinomas overall [1]. Open radical nephroureterectomy (ONU), with excision of the ipsilateral bladder cuff, is the standard treatment for UTUC [2, 3]. However, laparoscopic radical nephroureterectomy (LNU), first performed by Clayman et al. in 1991, has emerged as an accepted minimally invasive treatment alternative to ONU [4]. Subsequently, there have been numerous retrospective reports comparing the oncological outcomes between ONU and LNU [5–18] and one prospective series [19]. To date, none of the studies have shown a significant difference between the techniques in terms of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Only one study showed that there was a trend toward an independent association between surgical approach and RFS [13], and three studies showed a higher risk of intravesical RFS with LNU [7, 20, 21]. However, these studies focused on the oncological outcomes among the entire cohort of UTUC patients. Especially, they included a great many pTa stage and organ-confined UTUC. As experience with LNU grows, case selection has expanded to include more complex cases, resulting in carefully selected localized and/or locally advanced UTUC and larger tumors being operated on laparoscopically. However, until recently, only one study has focused on the oncological outcomes of LNU in t (...truncated)


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Jian-Ye Liu, Ying-Bo Dai, Fang-Jian Zhou, Zhi Long, Yong-Hong Li, Dan Xie, Bin Liu, Jin Tang, Jing Tan, Kun Yao, Le-Ye He. Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study, BMC Surgery, 2017, pp. 8, 17, DOI: 10.1186/s12893-016-0202-x