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Minerva Urologica e Nefrologica 2021 Jan 13

DOI: 10.23736/S0393-2249.20.04127-2


language: English

A comparison of perioperative outcomes of laparoscopic versus open nephroureterectomy for upper tract urothelial carcinoma: a propensity score matching analysis

Luca AFFERI 1 , Mohammad ABUFARAJ 2, 3, 4, Francesco SORIA 2, 5, David D’ANDREA 2, Evanguelos XYLINAS 6, Thomas SEISEN 7, Morgan ROUPRET 7, Chiara LONATI 1, 8, Alexandre De la TAILLE 9, Benoit PEYRONNET 10, Ekaterina LAUKHTINA 2, 11, Benjamin PRADERE 2, 12, Andrea MARI 13, Wojciech KRAJEWSKI 14, Mario ALVAREZ-MAESTRO 15, Eiji KIKUCHI 16, Keisuke SHIGETA 16, Piotr CHLOSTA 17, Francesco MONTORSI 18, Alberto BRIGANTI 18, Giuseppe SIMONE 19, Paola I. ORNAGHI 20, Maria Angela CERRUTO 20, Alessandro ANTONELLI 20, Kazumasa MATSUMOTO 21, Pierre I. KARAKIEWICZ 22, Livio MORDASINI 1, Agostino MATTEI 1, Shahrokh F. SHARIAT 2, 11, 23, 24, 25, Marco MOSCHINI 1, 2, 18

1 Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; 2 Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; 3 Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; 4 The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan; 5 Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy; 6 Department of Urology Bichat Hospital, Paris Descartes University, Paris, France; 7 Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris 6, Paris, France; 8 Department of Urology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy; 9 Department of Urology, Centre Hospitalier Universitaire Mondor Assistance Publique des Hôpitaux de Paris, Paris, France; 10 Department of Urology, Hopital Pontchaillou (CHU) Rennes, University of Rennes, Rennes, France; 11 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 12 Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France, Pierre et Marie Curie University, Paris, France; 13 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; 14 Department of Urology and Oncologic Urology, Wroclaw Medical University, Poland; 15 Department of Urology, Hospital Universitario La Paz, Madrid, Spain; 16 Department of Urology, Keio University School of Medicine, Tokyo, Japan; 17 Department of Urology, Jagiellonian University, Krakow, Poland; 18 Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; 19 Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy; 20 Department of Urology, University of Verona, Verona, Italy; 21 Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan; 22 Department of Urology, University of Montreal, Montreal, Quebec, Canada; 23 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 24 Department of Urology, Weill Cornell Medical College, New York, NY, USA; 25 Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic


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) 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.

KEY WORDS: Upper tract urothelial carcinoma; UTUC; RNU; Laparoscopic; Open; Radical nephroureterectomy; Perioperative outcomes

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