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

Nico C Grossmann; Francesco Soria; Tristan Juvet; Aaron M Potretzke; Hooman Djaladat; Alireza Ghoreifi; Eiji Kikuchi; Andrea Mari; Zine-Eddine Khene; Kazutoshi Fujita; Jay D Raman; Alberto Breda; Matteo Fontana; John P Sfakianos; John L Pfail; Ekaterina Laukhtina; Pawel Rajwa; Maximillian Pallauf; Cédric Poyet; Giovanni E Cacciamani; Thomas van Doeveren; Joost L Boormans; Alessandro Antonelli; Marcus Jamil; Firas Abdollah; Guillaume Ploussard; Axel Heidenreich; Enno Storz; Siamak Daneshmand; Stephen A Boorjian; Morgan Rouprêt; Michael Rink; Shahrokh F Shariat; Benjamin Pradere

doi:10.3390/cancers15051409

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

Cancers (Basel). 2023 Feb 23;15(5):1409. doi: 10.3390/cancers15051409.

Authors

Nico C Grossmann^{1

2

3}, Francesco Soria⁴, Tristan Juvet⁵, Aaron M Potretzke⁶, Hooman Djaladat⁷, Alireza Ghoreifi⁷, Eiji Kikuchi⁸, Andrea Mari⁹, Zine-Eddine Khene¹⁰, Kazutoshi Fujita¹¹, Jay D Raman¹², Alberto Breda¹³, Matteo Fontana¹³, John P Sfakianos¹⁴, John L Pfail¹⁴, Ekaterina Laukhtina^{1

15}, Pawel Rajwa^{1

16}, Maximillian Pallauf^{1

17

18}, Cédric Poyet², Giovanni E Cacciamani¹⁹, Thomas van Doeveren²⁰, Joost L Boormans²⁰, Alessandro Antonelli²¹, Marcus Jamil²², Firas Abdollah²², Guillaume Ploussard²³, Axel Heidenreich^{1

24}, Enno Storz²⁴, Siamak Daneshmand⁷, Stephen A Boorjian⁶, Morgan Rouprêt²⁵, Michael Rink²⁶, Shahrokh F Shariat^{1

15

27

28

29

30

31}, Benjamin Pradere^{1

23}

Affiliations

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.

Keywords: RNU; UTUC; surgical approach; transitional cell carcinoma; treatment outcomes.

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.