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Minerva Urology and Nephrology 2022 February;74(1):49-56

DOI: 10.23736/S2724-6051.20.04127-2


lingua: Inglese

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 A. 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, University Hospital of Vienna, Vienna, Austria; 3 Division of Urology, Department of Special Surgery, Jordan University Hospital, University of Jordan, Amman, Jordan; 4 National Center for Diabetes, Endocrinology and Genetics, University of Jordan, Amman, Jordan; 5 Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy; 6 Department of Urology Bichat Hospital, Paris Descartes University, Paris, France; 7 Pierre et Marie Curie Medical School, Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris (APHP), University of Paris6, Paris, France; 8 Department of Urology, University of Brescia, Spedali Civili Hospital, Brescia, Italy; 9 Department of Urology, Henri-Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), 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 (APHP), Pierre et Marie Curie University, Paris, France; 13 Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; 14 Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland; 15 Department of Urology, La Paz University Hospital, Madrid, Spain; 16 School of Medicine, Department of Urology, Keio University, Tokyo, Japan; 17 Department of Urology, Jagiellonian University, Krakow, Poland; 18 Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; 19 Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy; 20 Department of Urology, University of Verona, Verona, Italy; 21 School of Medicine, Department of Urology, Kitasato University, Kanagawa, Japan; 22 Department of Urology, University of Montreal, Montreal, QC, Canada; 23 Department of Urology, Southwestern Medical Center, Dallas, University of Texas, TX, USA; 24 Department of Urology, Weill Cornell Medical College, New York, NY, USA; 25 Department of Urology, Second Faculty of Medicine, Charles University, Prague, 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; 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.

KEY WORDS: Carcinoma, transitional cell; Laparoscopy; Nephroureterectomy

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