Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma.
OBJECTIVE
To compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in upper urinary tract urothelial carcinoma (UTUC) patients.


METHODS
We retrospectively analyzed the data of 371 UTUC patients who underwent ORNU (n = 271) or LRNU (n = 100) between 1992 and 2012. The survival outcomes included intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS). The Kaplan-Meier method and log-rank test were used to estimate and compare survival curves between groups. Factors associated with survival outcomes were evaluated using univariable and multivariable Cox proportional hazard models.


RESULTS
The three-year IVR-free survival rates were similar between the ORNU and LRNU groups (59.9 and 61.7 %, p = 0.267). However, the LRNU group showed worse five-year OS (59.1 vs. 75.2 %, p = 0.027) and CSS (66.1 vs. 80.2 %, p = 0.015) rates than the ORNU group. In particular, on stratifying the study cohort by pathological stages, significant differences in OS (p = 0.007) and CSS (p = 0.005) between the surgical approaches were observed only in locally advanced disease (pT3/T4). In multivariable analysis, LRNU was an independent predictor of worse OS (p = 0.001) and CSS (p = 0.006) than ORNU. Likewise, in multivariable analysis in patients with pT3/T4 stage, LRNU was significantly associated with worse OS (hazard ratio [HR] 2.59, p = 0.001) and CSS (HR 2.50, p = 0.005).


CONCLUSIONS
Our data suggest that in UTUC patients, LRNU, compared to ORNU, is generally associated with unfavorable OS and CSS results. In particular, LRNU should be performed in locally advanced UTUC patients after careful consideration of its impact on patient survival.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Hyung Suk
HS
Kim
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Ja Hyeon
JH
Ku
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Chang Wook
CW
Jeong
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Cheol
C
Kwak
Department of Urology, Seoul National University College of Medicine, Seoul, Korea. hhkim@snu.ac.kr.|Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. hhkim@snu.ac.kr.
Hyeon Hoe
HH
Kim
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
Laparoscopic; Open; Radical nephroureterectomy; Survival; Upper tract urothelial carcinoma