Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases |
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| Authors: | Umberto Capitanio,Shahrokh F. Shariat,Hendrik Isbarn,Alon Weizer,Mesut Remzi,Marco Roscigno,Eiji Kikuchi,Jay D. Raman,Christian Bolenz,Karim Bensalah,Theresa M. Koppie,Wassim Kassouf,Mario I. Ferná ndez,Philipp Strö bel,Jeffrey Wheat,Richard Zigeuner,Cord Langner,Matthias Waldert,Mototsugu Oya,Charles C. Guo,Casey Ng,Francesco Montorsi,Christopher G. Wood,Vitaly Margulis,Pierre I. Karakiewicz |
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| Affiliation: | 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada;2. Department of Urology, Vita-Salute San Raffaele, Milan, Italy;3. Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA;4. University of Michigan, Ann Arbor, MI, USA;5. Medical University of Vienna, Vienna, Austria;6. Keio University School of Medicine, Tokyo, Japan;g Cornell University, New York, NY, USA;h Mannheim Medical Center, University of Heidelberg, Mannheim, Germany;i University of Rennes, Rennes, France;j University of California Davis, Sacramento, CA, USA;k McGill University, Montreal, Quebec, Canada;l Clinica Alemana de Santiago, Santiago, Chile;m Medical University Graz, Graz, Austria;n University of Texas M.D. Anderson Cancer Center, Houston, TX, USA |
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| Abstract: | BackgroundData regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce.ObjectiveWe compared recurrence and cause-specific mortality rates of ONU and LNU.Design, setting, and participantsThirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC).MeasurementsUnivariable and multivariable survival models tested the effect of procedure type (ONU [n = 979] vs LNU [n = 270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment.Results and limitationsMedian follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p < 0.001) and less lymphovascular invasion (14.8% vs 21.3%, p = 0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p = 0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p < 0.001] and 2.0 [p = 0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p = 0.1 for both).ConclusionsShort-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC. |
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| Keywords: | Laparoscopy Nephroureterectomy Recurrence Survival Upper tract urothelial carcinoma |
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