title: Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study.
abstract: BACKGROUND
  The purpose of this study was to compare the postsurgical survival of UUT-UC patients treated with ONU and LNU.
  
  
  METHODS
  Using a multi-institutional, national, retrospective database, we identified patients with UUT-UC who underwent radical nephroureterectomy by open access (ONU) or by the minimally invasive alternative (LNU). Survival curves were estimated using Kaplan-Meier method. A multivariate Cox model was used to evaluate the association between surgical approach and disease recurrence.
  
  
  RESULTS
  Overall, 609 patients were included (ONU = 459 and LNU = 150). The median age was 69.8 years (range 61.9-76), and the male-to-female ratio was 2:1. Postoperative complications occurred in 80 patients, with no significant difference between ONU and LNU on the whole (P = 0.64). The median follow-up was 27 months. There was no difference between the 2 procedures in the 5-year CSS or 5-year RFS. Moreover, the 5-year CSS (P = 0.053) and 5-year RFS (P = 0.9) for cases with locally advanced disease (pT3/pT4) were similar between ONU and LNU. In the multivariate analysis, the surgical procedure used was not found to be associated with survival. The main limitation of the study is its retrospective design, which is the result of the rarity of the disease.
  
  
  CONCLUSIONS
  There is no evidence that oncological outcomes for LNU are inferior to those for open surgery, provided that the appropriate precautionary measures are taken.
authors.affiliation: Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors.forename: Mehdi Mokhtar
authors.initials: MM
authors.lastname: Ariane
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Geraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Marie
authors.initials: M
authors.lastname: Audouin
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Cornu
authors.forename: Baptiste
authors.initials: B
authors.lastname: Albouy
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: Sébastien
authors.initials: S
authors.lastname: Crouzet
authors.forename: Sophie
authors.initials: S
authors.lastname: Hurel
authors.forename: Frederic
authors.initials: F
authors.lastname: Arroua
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.forename: Charles
authors.initials: C
authors.lastname: Marchand
authors.forename: Pierre Olivier
authors.initials: PO
authors.lastname: Fais
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Fabien
authors.initials: F
authors.lastname: Saint
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ravier
authors.forename: Alexandre
authors.initials: A
authors.lastname: Matte
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*