title: Laparoscopic Versus Open Nephroureterectomy in Muscle-Invasive Upper Tract Urothelial Carcinoma: Subanalysis of the Multi-Institutional National Database of the Japanese Urological Association.
abstract: Open nephroureterectomy (ONU) is the current standard for muscle-invasive upper tract urothelial carcinoma (UTUC) in the European Association of Urology/Japanese Urological Association (JUA) guidelines. In this study, we compared the postsurgical survival of muscle-invasive UTUC patients treated with ONU or with laparoscopic nephroureterectomy (LNU), using the multi-institutional national database of the JUA.
  
  
  
  The 1509 patients with UTUC who were diagnosed at 348 Japanese institutions in 2005 were registered. We collected the clinical data of the patients in 2011. The muscle-invasive UTUC patients who underwent ONU or LNU were identified, and survival curves were estimated using the Kaplan-Meier method.
  
  
  
  Overall, 749 pT2≥cNxM0 patients underwent a nephroureterectomy (ONU, n = 527 and LNU, n = 222). The overall survival and cause-specific survival rates were not significantly different between the ONU and LNU groups (p = 0.1263 and p = 0.0893, respectively). In addition, 459 of the 749 (61.3%) patients experienced disease recurrence (bladder recurrence, local recurrence, or distant metastasis), with no significant difference between the ONU and LNU groups. Even when patients were stratified by pT3/pT4 and/or pN+, overall survival was not significantly different between the ONU and LNU groups (p = 0.2876). The results of a univariate analysis showed that lymphovascular invasion was an independent prognostic factor for overall survival, but the surgical approaches were not found to be associated with overall survival.
  
  
  
  Our data suggest that there is no evidence that the oncologic outcome of LNU is inferior to that of ONU in muscle-invasive UTUC, when the appropriate patients are selected.
authors.affiliation: 1 Department of Urology, Faculty of Medicine, University of Tsukuba , Ibaraki, Japan .
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: 1 Department of Urology, Faculty of Medicine, University of Tsukuba , Ibaraki, Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
authors.affiliation: 2 Urology Division, National Cancer Center Hospital , Tokyo, Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujimoto
authors.affiliation: 3 Department of Urology, Hirosaki University Graduate School of Medicine , Hirosaki, Japan .
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.affiliation: 3 Department of Urology, Hirosaki University Graduate School of Medicine , Hirosaki, Japan .
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.affiliation: 4 Center for Innovative Clinical Medicine, Okayama University Hospital , Okayama, Japan .
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.affiliation: 5 Department of Urology, Keio University School of Medicine , Tokyo, Japan .
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: 6 Department of Urology, Cancer Institute Hospital , Japanese Foundation of Cancer Research, Tokyo, Japan .
authors.forename: Mizuaki
authors.initials: M
authors.lastname: Sakura
authors.affiliation: 7 Department of Urology, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan .
authors.forename: Junichi
authors.initials: J
authors.lastname: Inokuchi
authors.affiliation: 2 Urology Division, National Cancer Center Hospital , Tokyo, Japan .
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012955:Societies, Medical; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology; D014572:Urology / Q000379:methods*; D019459:Urothelium / Q000473:pathology