title: Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study.
abstract: BACKGROUND
  Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1-4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1-4/N0-XUTUC.
  
  
  METHODS
  We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1-4/N0-XUTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox's proportional hazards model was used for univariate and multivariate analysis.
  
  
  RESULTS
  The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46-3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54-1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616-3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81-3.17, P = 0.17).
  
  
  CONCLUSIONS
  The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1-4/N0-XUTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Jian-Ye
authors.initials: JY
authors.lastname: Liu
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Ying-Bo
authors.initials: YB
authors.lastname: Dai
authors.affiliation: Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.|State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
authors.forename: Fang-Jian
authors.initials: FJ
authors.lastname: Zhou
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Long
authors.affiliation: Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.|State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.|State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Tang
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China. heleye_csu@163.com.|Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China. heleye_csu@163.com.
authors.forename: Le-Ye
authors.initials: LY
authors.lastname: He
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopic radical nephroureterectomy; Oncological; Open radical nephroureterectomy; Outcomes; Recurrent; Survival; Upper tract urothelial carcinoma