title: A Comparison of 30-Day Perioperative Outcomes in Open Versus Minimally Invasive Nephroureterectomy for Upper Tract Urothelial Carcinoma: Analysis of 896 Patients from the American College of Surgeons-National Surgical Quality Improvement Program Database.
abstract: OBJECTIVE
  Minimally invasive surgery for nephroureterectomy (MINU) in patients with upper tract urothelial carcinoma (UTUC) is increasingly used among urologists with reported equivalent oncologic outcomes compared with open nephroureterectomy (ONU). Population-level data comparing perioperative outcomes between these approaches remain limited, however. We sought to compare perioperative outcomes between MINU and ONU in a prospectively collected national cohort of patients.
  
  
  METHODS
  Between 2006 and 2012, patients who underwent nephroureterectomy for UTUC within the American College of Surgeons-National Surgical Quality Improvement Program database were categorized into MINU or ONU. Our primary outcome of interest was 30-day perioperative complications. Secondary outcomes included use of lymph node dissection (LND), transfusion, reintervention and readmission rate, operative time, length of stay (LOS), and perioperative mortality. Multivariable logistic regression analyses were used to examine the association between outcomes and surgical approach.
  
  
  RESULTS
  A total of 599 (66.9%) and 297 (33.1%) patients underwent MINU and ONU, respectively. Overall, 12.7% of patients experienced a complication within 30 days postoperatively, and the rate did not differ among surgical approaches. Patients in the MINU group, however, had a decreased LOS (P<0.001). On multivariable analysis, patients receiving MINU were less likely to undergo a LND (OR 0.13; P<0.001), had decreased risk of thromboembolic complications (odds ratio [OR] 0.13; P=0.018), decreased need for transfusion (OR 0.39; P=0.001), and decreased need for operative reintervention (OR 0.24; P=0.024).
  
  
  CONCLUSIONS
  Patients receiving MINU have similar overall complication rates compared with ONU. MINU, however, was associated with a decreased risk of blood transfusions, thromboembolic events, reintervention, and overall LOS compared with ONU. MINU should be considered as a primary approach in select groups of patients with UTUC.
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|2 Department of Urology, Marien Hospital, Ruhr-University Bochum , Herne, Germany .
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: 3 Department of Urology, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Department of Urology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany .
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Department of Urology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany .
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: 5 Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute , Henry Ford Health System, Detroit, Michigan.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: 3 Department of Urology, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Feldman
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: 5 Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute , Henry Ford Health System, Detroit, Michigan.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: 5 Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute , Henry Ford Health System, Detroit, Michigan.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.affiliation: 2 Department of Urology, Marien Hospital, Ruhr-University Bochum , Herne, Germany .
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000592:standards; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D016017:Odds Ratio; D011446:Prospective Studies; D058996:Quality Improvement; D066231:Surgeons; D016896:Treatment Outcome; D014481:United States; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000601:surgery*