scholarly journals Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Ching-Chia Li ◽  
Chao-Hsiang Chang ◽  
Chi-Ping Huang ◽  
Jian-Hua Hong ◽  
Chao-Yuan Huang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Urothelial Carcinoma ◽  
Surgical Complications ◽  
Survival Rates ◽  
Upper Tract Urothelial Carcinoma ◽  
Survival Outcomes ◽  
Oncological Outcomes ◽  
Kaplan Meier ◽  
Robotic Nephroureterectomy ◽  
Laparoscopic Nephroureterectomy

PurposeThis study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy.MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches.ResultsAmong the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001).ConclusionsMinimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.

scholarly journals The oncological outcomes after pluck method laparoscopic nephroureterectomy for upper tract urothelial carcinoma

2016 ◽  
Vol 27 (2) ◽  
pp. S45
Author(s):  
Jen-Shu Tseng ◽  
Chih-Chiao Lee ◽  
Ting-Po Lin ◽  
Marcelo Chen ◽  
Huang-Kuang Chang ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
Laparoscopic Nephroureterectomy

scholarly journals Risk Factor Analysis of Intravesical Recurrence After Laparoscopic Nephroureterectomy for Upper Tract Urothelial Carcinoma

2021 ◽  
Author(s):  
Masato Yanagi ◽  
Tsutomu Hamasaki ◽  
JunJun Akatsuka ◽  
Yuki Endo ◽  
Hayato Takeda ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Survival Rates ◽  
Urine Cytology ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Positive Urine ◽  
Laparoscopic Nephroureterectomy

Abstract Background: One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after laparoscopic nephroureterectomy (LNU) for UTUC.Methods: Clinicopathological and surgical information were collected from the medical records of 73 patients treated with LNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after LNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoperitoneum time, was analyzed using Cox proportional hazards regression models and the Kaplan–Meier method with log-rank test.Results: During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after LNU. The 3- and 5-year IVR-free survival rates were 76.5% and 74.3%, respectively. In the multivariate Cox regression analysis, positive preoperative urine cytology (hazard ratio [HR]: 3.55; 95% confidence interval [CI]: 1.326–11.327; p=0.011) and prolonged pneumoperitoneum time of ≥ 210 min (HR: 3.40; 95% CI: 1.271–10.692; p=0.014) were independent prognostic factors for IVR-free survival. In patients with positive urine cytology, the Kaplan–Meier method with log-rank test revealed that the 3-year and 5-years IVR free survival rates were 46.3% and 39.7%, respectively, in patients with a prolonged pneumoperitoneum time of ≥ 210 min, which was significantly lower than that in their counterparts (76% and 76%, respectively, p=0.041).Conclusions: In UTUC patients with positive urine cytology, the occurrence of IVR is highly probable when the pneumoperitoneum time of LNU is prolonged (≥ 210 min). Strict follow-up after LNU is highly recommended for these patients.

Single-stage minimally invasive nephroureterectomy for upper tract urothelial carcinoma: Perioperative and early oncological outcomes

2020 ◽  
Vol 13 (5) ◽  
pp. 332-338
Author(s):  
PC Ryan ◽  
UM Haroon ◽  
RA Keenan ◽  
PJ O’Donoghue ◽  
M Hegazy ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Urothelial Carcinoma ◽  
Single Stage ◽  
Upper Tract Urothelial Carcinoma ◽  
Perioperative Outcomes ◽  
Minimally Invasive Techniques ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
Invasive Techniques

Objective: The purpose of this article is to present our minimally-invasive techniques for upper tract urothelial carcinoma and review the perioperative and early oncological outcomes at our centre. Materials and methods: A retrospective review of all patients undergoing minimally-invasive surgery for upper tract urothelial carcinoma over a 3-year period following institutional approval was performed. Perioperative and early oncological outcomes were assessed. Results: Twenty-three cases of minimally-invasive single-stage nephroureterectomy were performed with a mean patient age of 69.45 years. Twelve (52%) of these cases were for high-grade disease and six (27%) had received neo-adjuvant chemotherapy. There were no intraoperative complications, no positive surgical margins and four (17.4%) of patients had a post-operative complication. Mean length of stay was 5.5 days and there was one readmission within 30 days of surgery. Seven patients (30%) experienced either local or distant recurrences with a median time to recurrence of 6 months. Recurrence free survival was 69.6%. Two patients died during the follow-up period. Conclusion: Our minimally-invasive techniques provides a safe and reproducible approach for upper tract urothelial carcinoma. Our perioperative outcomes and oncological are comparable to similar studies, but more long-term follow-up and larger patient numbers are required to validate oncological efficacy. Level of evidence: 4.

scholarly journals Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan

2022 ◽  
Vol 11 ◽  
Author(s):  
I-Hsuan Alan Chen ◽  
Chao-Hsiang Chang ◽  
Chi-Ping Huang ◽  
Wen-Jeng Wu ◽  
Ching-Chia Li ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Minimally Invasive ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
Predicting Factors

BackgroundTaiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking.ObjectiveThis study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan.MethodsA multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors.ResultsWith a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU.ConclusionSynchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control.

scholarly journals Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2063 ◽  
Author(s):  
Su Zhang ◽  
You Luo ◽  
Cheng Wang ◽  
Sheng-Jun Fu ◽  
Li Yang
Keyword(s):  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Surgical Approaches ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Upper Tract ◽  
Oncological Outcomes ◽  
Hazard Ratios ◽  
Laparoscopic Nephroureterectomy

Background.Several factors have been validated as predictors of disease recurrence in upper tract urothelial carcinoma. However, the oncological outcomes between different surgical approaches (open nephroureterectomy versus laparoscopic nephroureterectomy, ONU vs LNU) remain controversial. Therefore, we performed a meta-analysis to evaluate the oncological outcomes associated with different surgical approaches.Methods.We conducted an electronic search of the PubMed, Embase, ISI Web of Knowledge and Cochrane Library electronic databases through November 2015, screened the retrieved references, collected and evaluated the relevant information. We extracted and synthesized the corresponding hazard ratios (HRs) and 95% confidence intervals (95% CI) using Stata 13.Results.Twenty-one observational studies were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed no differences in the intravesical recurrence-free survival (IRFS), unspecified recurrence-free survival (UnRFS) and overall survival (OS) between LNUandONU. However, improvements in the extravesical recurrence free survival (ExRFS) and cancer specific survival (CSS) were observed inLNU. The pooled hazard ratios were 1.05 (95% CI [0.92–1.18]) for IRFS, 0.80 (95% CI [0.64–0.96]) for ExRFS, 1.10 (95% CI [0.93–1.28]) for UnRFS, 0.91 (95% CI [0.66–1.17]) for OS and 0.79 (95% CI [0.68–0.91]) for CSS.Conclusion.Based on current evidence, LNU could provide equivalent prognostic effects for upper tract urothelial carcinoma, and had better oncological control of ExRFS and CSS compared to ONU. However, considering all eligible studies with the intrinsic bias of retrospective study design, the results should be interpreted with caution. Prospective randomized trials are needed to verify these results.

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