SUO 2017: Robot-assisted Versus Laparoscopic Nephroureterectomy For Upper Tract Urothelial Carcinoma: Short-term Outcomes From The National Cancer Database

Washington, DC ( Introduction: Minimally invasive nephroureterectomy (MINU), including laparoscopic nephroureterectomy (LNU) and robot assisted nephroureterectomy (RANU), has been increasingly used for the management of upper tract urothelial carcinoma (UTUC). Limited data exist on whether RANU has advantages over LNU in perioperative safety profiles and short-term outcomes.

Methods: The authors identified patients with non-metastatic UTUC who underwent RANU or LNU from 2010 to 2013 in the National Cancer Database (NCDB). Unadjusted analyses and multivariable logistic regressions adjusted for patient (age, sex, race, comorbidity, and insurance), tumor (location, grade, size, cT, and cN), and facility (type and MIRN volume) characteristics were
used to compare several outcomes. These included 30-day mortality, 90-day mortality, conversion (to open surgery), prolonged length of stay (PLOS, ≥6 days), and 30-day readmission rates between RANU and LNU.

Results: A total of 5,197 patients (RANU, n=1,777; LNU, n= 3,420) were included. From 2010 to 2013, there was a trend of increasing RANU usage and decreasing LNU usage among all the MINU cases. Unadjusted comparisons showed significantly lower 90-day mortality rate (2.19% vs. 3.45%) and fewer patients had conversion (5.29% vs. 10.73%) and PLOS (21.38% vs. 29.53%) in the RANU group versus LNU group. Multivariable logistic regressions analyses in the overall cohort showed that RANU was associated with lower odds of 90-day mortality (OR=0.67, 95%CI=0.46-0.97, P=0.035), conversion (OR=0.46, 95%CI=0.46-0.58, P<0.001), and PLOS (OR=0.67, 95%CI=0.58-0.77, P<0.001). Secondary multivariable logistic regressions in the cohort of patients without open conversion (n= 4,736) still showed that RANU was associated with lower odds of 90-day mortality (OR=0.66, 95%CI=0.43-0.99, P= 0.047) and PLOS (OR=0.69, 95%CI=0.59-0.79, P<0.001). 30-day mortality and readmission rates were similar between the two groups in both unadjusted analyses and multivariable logistic regressions.

Conclusion: Compared with LNU, RANU may provide better perioperative safety profiles and short-term outcomes. Future prospective studies are needed to validate our findings.

Presented by: Leilei Xia, New York, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC