What's known on the subject? and What does the study add?
Open radical nephroureterectomy (
ORNU) with excision of the ipsilateral bladder cuff is a standard treatment for upper tract urothelial carcinoma ( UTUC). However, over the past decade laparoscopic RNU( LRNU) has emerged as a minimally invasive surgical alternative. Data comparing the oncological efficacy of ORNUand LRNUhave reported mixed results and the equivalence of these surgical techniques have not yet been established.
We found that surgical approach was not independently associated with overall or disease‐specific survival; however, there was a trend toward an independent association between
LRNUand poorer recurrence‐free survival ( RFS). To our knowledge, this is the first large, multi‐institutional analysis to show a trend toward inferior RFSin patients with UTUCtreated with LRNU. Objective
To examine the association between surgical approach for radical nephroureterectomy (
RNU) and clinical outcomes in a large, multi‐institutional cohort, as there are limited data comparing the oncological efficacy of open RNU( ORNU) and laparoscopic RNU( LRNU) for upper urinary tract urothelial carcinoma ( UTUC). Patients and Methods
RNUdatabases containing detailed information on patients with UTUCtreated between 1994 and 2009 were obtained from 10 academic centres in Canada.
Data were collected on 1029 patients and combined into a relational database formatted with patient characteristics, pathological characteristics, and survival status.
Surgical approach was classified as
ORNU( n= 403) or LRNU( n= 446).
The clinical outcomes were overall survival (
OS), disease‐specific survival ( DSS), and recurrence‐free survival ( RFS). The Kaplan–Meier method and Cox proportional regression analysis were used to analyse survival data. Results
Data were evaluable for 849 of 1029 (82.5%) patients.
The median (interquartile range) follow‐up duration was 2.2 (0.6–5.0) years.
The predicted 5‐year
OS(67% vs 68%, log‐rank P= 0.19) and DSS(73% vs 76%, log‐rank P= 0.32) rates did not differ between the ORNUand LRNUgroups; however, there was a trend toward an improved predicted 5‐year RFSrate in the ORNUgroup (43% vs 33%, log‐rank P= 0.06).
Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with
OS(hazard ratio [ HR] 0.89, 95% confidence interval [ CI] 0.63–1.27, P= 0.52) or DSS( HR0.90, 95% CI0.60–1.37, = 0.64); however, there was a trend toward an independent association between surgical approach and P RFS( HR1.24, 95% CI0.98–1.57, = 0.08). P Conclusion
Surgical approach was not independently associated with
OSor DSSbut there was a trend toward an independent association between LRNUand poorer RFS. Further prospective evaluation is needed.