Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series.
BACKGROUND
Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort.


OBJECTIVE
Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort.


METHODS
We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients.


METHODS
All patients underwent NU.


METHODS
The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching.


CONCLUSIONS
For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p<0.001); intraoperative complications, 4.7% versus 2.1% (p=0.002); postoperative complications, 17% versus 15% (p=0.24); pLOS (≥5 d), 47% versus 28% (p<0.001); in-hospital mortality, 1.3% versus 0.7% (p=0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p<0.001), to experience any intraoperative complications (OR: 0.4; p=0.002), and to have a pLOS (OR: 0.4; p<0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p=0.007). This study is limited by its retrospective nature.


CONCLUSIONS
After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. nawarhanna10@gmail.com
Nawar
N
Hanna
Maxine
M
Sun
Quoc-Dien
QD
Trinh
Jens
J
Hansen
Marco
M
Bianchi
Francesco
F
Montorsi
Shahrokh F
SF
Shariat
Markus
M
Graefen
Paul
P
Perrotte
Pierre I
PI
Karakiewicz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery*; D055815:Young Adult