To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset.
Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes.
Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR.
Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.
Annals of surgical oncology. 2020 Aug 25 [Epub ahead of print]
Keisuke Shigeta, Kazuhiro Matsumoto, Toshikazu Takeda, Seiya Hattori, Gou Kaneko, Masashi Matsushima, Takayuki Abe, Nobuyuki Tanaka, Ryuichi Mizuno, Hiroshi Asanuma, Eiji Kikuchi, Mototsugu Oya
Department of Urology, Keio University School of Medicine, Tokyo, Japan., Department of Urology, Keio University School of Medicine, Tokyo, Japan. ., Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan., Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan., Department of Urology, Ogikubo Hospital, Tokyo, Japan., Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan., Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan.