BACKGROUND: Radical nephroureterectomy (RNU) with the concomitant excision of the distal ureter and bladder cuff is the current standard of care for the treatment of muscle invasive and/or high-risk upper tract urothelial carcinoma (UTUC). In small uncontrolled studies, laparoscopic RNU has been suggested to be associated with better perioperative outcomes compared to open RNU. The aim of our study was to compare the perioperative oncological and functional outcomes of open RNU versus laparoscopic RNU after adjusting for preoperative baseline patient-related characteristics. METHODS: We evaluated a multi-institutional retrospective database composed by 1512 patients diagnosed with UTUC and treated with open or laparoscopic RNU between 1990 and 2016. Perioperative outcomes included operative time, blood loss, and length of hospital stay, as well as postoperative complications, readmission, reoperation, and mortality rates at 30 and 90 days from surgery. A 1:1 propensity score matching estimated using logistic regression with the teffects psmatch function of STATA 13® (caliper 0.2, no replacement; StataCorp LLC; College Station, TX, USA) was performed using preoperative parameters such as: age, gender, Body Mass Index (BMI), and American Society of Anesthesiologists (ASA) Score. RESULTS: Overall, 1007 (66.6%) patients were treated with open and 505 (33.4%) with laparoscopic RNU. Open RNU resulted into shorter median operative time (180 vs. 230 min, P<0.001) and longer median hospital stay (10 vs. 7 days, P<0.001) in comparison to laparoscopic RNU. No statistically significant difference was identified for the other variables of interest (all P>0.05). At multivariable linear regression after propensity score matching adjusted for lymph node dissection and year of surgery, laparoscopic RNU resulted in longer operative time (coefficient 43.6, 95% CI 27.9-59.3, P<0.001) and shorter hospital stay (coefficient -1.27, 95% CI -2.1 to -0.3, P=0.01) compared to open RNU, but the risk of other perioperative complications remained similar between the two treatments. CONCLUSIONS: Laparoscopic RNU is associated with shorter hospital stay, but longer operative time in comparison to open RNU. Otherwise, there were no differences in other perioperative outcomes between these surgical modalities even after propensity score matching. The choice to offer laparoscopic or open RNU in the treatment of UTUC should not be based on concerns of different safety outcomes.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology and Oncologic Urology Wroclaw Medical University Wroclaw Poland

Department of Urology and quot;Regina Elena and quot; National Cancer Institute Rome Italy

Department of Urology Bichat Hospital Paris Descartes University Paris France

Department of Urology Careggi Hospital University of Florence Florence Italy

Department of Urology Henri Mondor University Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Urology Hopital Pontchaillou Rennes University of Rennes Rennes France

Department of Urology Jagiellonian University Krakow Poland

Department of Urology La Paz University Hospital Madrid Spain

Department of Urology Luzerner Kantonsspital Lucerne Switzerland

Department of Urology Southwestern Medical Center Dallas University of Texas TX USA

Department of Urology Tenon Hospital Assistance Publique Hôpitaux de Paris Pierre et Marie Curie University Paris France

Department of Urology University of Brescia Spedali Civili Hospital Brescia Italy

Department of Urology University of Montreal Montreal QC Canada

Department of Urology University of Verona Verona Italy

Department of Urology Urological Research Institute IRCCS San Raffaele Hospital Vita Salute San Raffaele University Milan Italy

Department of Urology Vienna General Hospital University Hospital of Vienna Vienna Austria

Department of Urology Weill Cornell Medical College New York NY USA

Division of Urology Department of Special Surgery Jordan University Hospital University of Jordan Amman Jordan

Division of Urology Department of Surgical Sciences University of Turin Turin Italy

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

National Center for Diabetes Endocrinology and Genetics University of Jordan Amman Jordan

Pierre et Marie Curie Medical School Department of Urology Pitié Salpétrière Hospital Assistance Publique Hôpitaux de Paris University of Paris6 Paris France

School of Medicine Department of Urology Keio University Tokyo Japan

School of Medicine Department of Urology Kitasato University Kanagawa Japan

Citace poskytuje Crossref.org

Oncological outcomes of open versus minimally invasive nephroureterectomy for locally advanced upper tract urothelial carcinoma