Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases.
BACKGROUND
Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce.


OBJECTIVE
We compared recurrence and cause-specific mortality rates of ONU and LNU.


METHODS
Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC).


METHODS
Univariable 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.


CONCLUSIONS
Median 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).


CONCLUSIONS
Short-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.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Umberto
U
Capitanio
Shahrokh F
SF
Shariat
Hendrik
H
Isbarn
Alon
A
Weizer
Mesut
M
Remzi
Marco
M
Roscigno
Eiji
E
Kikuchi
Jay D
JD
Raman
Christian
C
Bolenz
Karim
K
Bensalah
Theresa M
TM
Koppie
Wassim
W
Kassouf
Mario I
MI
Fernández
Philipp
P
Ströbel
Jeffrey
J
Wheat
Richard
R
Zigeuner
Cord
C
Langner
Matthias
M
Waldert
Mototsugu
M
Oya
Charles C
CC
Guo
Casey
C
Ng
Francesco
F
Montorsi
Christopher G
CG
Wood
Vitaly
V
Margulis
Pierre I
PI
Karakiewicz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002278:Carcinoma in Situ; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods