Laparoscopic radical nephroureterectomy (LNU) has gradually become the new standard treatment for localized upper tract urothelial cancer (UTUC). With more blunt dissection and tactile sensation, hand-assisted LNU might shorten the operative time compared with the pure laparoscopic approach.
However, whether the use of the hand-assisted or the pure laparoscopic approach has an effect on oncological outcomes remains unclear.
We retrospectively identified 629 patients with non-metastatic UTUC who underwent hand-assisted (n = 515) or pure LNU (n = 114) at 9 hospitals in Taiwan between 2004 and 2019. Overall survival, cancer-specific survival, recurrence-free survival, and bladder recurrence-free survival were compared between these two groups using inverse-probability of treatment weighting (IPTW) derived from the propensity scores for baseline covariate adjustment.
The median follow-up period was 32.9 and 28.7 months in the hand-assisted and the pure groups, respectively. IPTW-adjusted Cox proportional hazards models showed that the laparoscopic approach (pure vs. hand-assisted) was not significantly associated with all-cause mortality (HR 0.79, 95% CI 0.49-1.24, p = 0.304), cancer-specific mortality (HR 0.88, 95% CI 0.51-1.51, p = 0.634), or extra-vesical recurrence (HR 0.65, 95% CI 0.41-1.04, p = 0.071). However, the pure laparoscopic approach was significantly associated with lower intra-vescial recurrence (HR 0.64, 95% CI 0.43-0.96, p = 0.029) for patients who underwent LNU. Kaplan-Meier curves also revealed that the pure laparoscopic approach was associated with better bladder recurrence-free survival compared with the hand-assisted laparoscopic approach in both the original cohort and the IPTW-adjusted cohort (log-rank p = 0.042 and 0.027, respectively).
The performance of hand-assisted or pure LNU does not significantly affect the all-cause mortality, cancer-specific mortality, or extra-vesical recurrence for patients with non-metastatic UTUC. However, the hand-assisted laparoscopic approach could increase the risk of intra-vesical recurrence for patients who undergo LNU.
Surgical endoscopy. 2021 Oct 29 [Epub ahead of print]
Chih-Chin Yu, Chung-Hsin Chen, Jian-Hua Hong, Hung-Lung Ke, Wei-Ming Li, Shiu-Dong Chung, Wei-Che Wu, Yung-Tai Chen, Yuan-Hong Jiang, Yu-Hua Lin, Wei-Yu Lin, Chia-Chang Wu, Yao-Chou Tsai
Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian, New Taipei City, Taiwan., Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan., Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan., Department of Urology, Postal Hospital, Taipei, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., Department of Surgery, Division of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan., Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian, New Taipei City, Taiwan. .