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

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; Lee; 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

doi:10.1186/s12894-024-01622-5

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

BMC Urol. 2024 Oct 21;24(1):231. doi: 10.1186/s12894-024-01622-5.

Authors

Jen-Kai Fang¹, Hsin-Chih Yeh^{2

3

4

5}, Hsiang-Ying Lee^{3

4

6}, Han-Yu Weng⁷, Ta-Yao Tai⁷, Chao-Yuan Huang⁸, Jian-Hua Hong^{8

9}, Chih-Chin Yu^{10

11}, Shu-Yu Wu^{10

11}, Shiu-Dong Chung^{12

13}, Chung-You Tsai^{13

14}, Thomas Y Hsueh^{15

16}, Allen W Chiu¹⁶, Yuan-Hong Jiang¹¹, Yu Khun¹, Lee¹¹, I-Hsuan Alan Chen¹⁷, Jen-Tai Lin¹⁷, Yung-Tai Chen^{8

18

19}, Chang-Min Lin¹⁹, Ian-Seng Cheong²⁰, Hsu-Che Huang^{21

22}, Shih-Hsiu Lo²³, Wei-Yu Lin^{24

25

26}, Jen-Shu Tseng^{27

28

29}, Chia-Chang Wu^{30

31

32}, Shian-Shiang Wang^{33

34

35}, Yi-Huei Chang¹, Chao-Hsiang Chang³⁶

Affiliations

¹ Department of Urology, China Medical University Hospital, China Medical university, Taichung, Taiwan.
² Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
⁹ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
¹⁰ Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹¹ Department of Urology, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹² Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
¹³ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁴ Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.
¹⁵ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.
¹⁶ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁷ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹⁸ Department of Urology, Postal Hospital, Taipei, Taiwan.
¹⁹ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
²⁰ Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, 600, Taiwan.
²¹ Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, 23148, Taiwan.
²² Department of Life Science, College of Science, National Taiwan Normal University, Taipei, 11677, Taiwan.
²³ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan.
²⁴ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
²⁵ Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
²⁶ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
²⁷ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
²⁸ Mackay Medical College, Taipei, Taiwan.
²⁹ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³⁰ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³¹ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³² TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³³ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
³⁴ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³⁵ Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan.
³⁶ Department of Urology, China Medical University Hospital, China Medical university, Taichung, Taiwan. [email protected].

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Minimally invasive surgery; Robotic surgery; Upper tract urothelial carcinoma.

Publication types

Multicenter Study
Comparative Study

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Transitional Cell* / mortality
Carcinoma, Transitional Cell* / surgery
Female
Humans
Kidney Neoplasms* / mortality
Kidney Neoplasms* / surgery
Laparoscopy* / methods
Male
Middle Aged
Neoplasm Staging
Nephroureterectomy* / methods
Retrospective Studies
Robotic Surgical Procedures* / methods
Treatment Outcome
Ureteral Neoplasms* / mortality
Ureteral Neoplasms* / surgery
Urinary Bladder / surgery