To compare the outcomes of robotic radical nephroureterectomy (RRNU) and laparoscopic radical nephroureterectomy (LRNU) within a large multi-institutional worldwide dataset.
The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) includes data from 17 centers worldwide regarding 877 RRNU and LRNU performed between 2015 and 2019.
Baseline features, perioperative and oncological outcomes, were included. A 2:1 nearest-neighbor propensity-score matching with a 0.001 caliper was performed. An univariable and a multivariable logistic regression model were built to evaluate the predictors of a composite "tetrafecta" outcome defined as occurrence of bladder cuff excision + LND + no complications + negative surgical margins.
After matching, 185 RRNU and 91 LRNU were assessed. Patients in the RRNU group were more likely to undergo bladder cuff excision (81.9% vs 63.7%; p<0.001) compared to the LRNU group. A statistically significant difference was found in terms of overall postoperative complications (p=0.003) and length of stay (p<0.001) in favor of RRNU. Multivariable analysis demonstrated that LRNU was an independent predictor negatively associated with achievement of "tetrafecta" (OR: 0.09; p=0.003).
In general, RRNU and LRNU offer comparable outcomes. While the rate of overall complications is higher for LRNU in this study population, this is mostly related to low grade complications, and therefore with more limited clinical relevance. RRNU seems to offer shorter hospital stay but this might also be related to the different geographical location of participating centers. Overall, the implementation of robotics might facilitate achievement of a "tetrafecta" outcome as defined in the present study.
Journal of endourology. 2022 Jan 12 [Epub ahead of print]
Alessandro Veccia, Umberto Carbonara, Hooman Djaladat, Reza Mehrazin, Daniel Eun, Adam C Reese, Xiaosong Meng, Robert Uzzo, Abhishek Srivastava, James Robert Porter, Jason Farrow, Marcus Jamil, Giuseppe Rosiello, Riccardo Tellini, Andrea Mari, Ali Al-Qathani, Koon Ho Rha, Linhui Wang, Riccardo Mastroianni, Matteo Ferro, Ottavio De Cobelli, Kevin Hakimi, Fabio Crocerossa, Alireza Ghoreifi, Giovanni Cacciamani, Amit Amit S Bhattu, Alexandre Mottrie, Firas Abdollah, Andrea Minervini, Zhenjie Wu, Giuseppe Simone, Ithaar H Derweesh, Mark L Gonzalgo, Vitaly Margulis, Chandru P Sundaram, Riccardo Autorino
Spedali Civili Hospital, University of Brescia, Department of Urology, Piazzale Spedali Civili 1, Brescia, Italy, 25123; ., Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233., Los Angeles, United States; ., Mount Sinai Health System, 5944, Urology, 5 East 98th St, 6th floor, New York, New York, United States, 10029; ., Temple University, Urology, 255 South 17th street, 7th Floor Urology Suite, Philadelphia, Pennsylvania, United States, 19103; ., Lewis Katz School of Medicine at Temple University, Urology, 3401 N Broad St., Suite 340, Philadelphia, Pennsylvania, United States, 19140; ., University of Texas Southwestern Medical Center, Urology, Dallas, Texas, United States; ., Fox Chase Cancer Center, 6565, 333 Cottman Ave, Philadelphia, Pennsylvania, United States, 19111; ., Philadelphia, United States; ., Swedish Medical Center, Urology, 1101 Madison, Suite 1400, Seattle, Washington, United States, 98104; ., Indiana University Health, 22529, Urology, 535 N Barnhill, Suite 150, Indianapolis, Indiana, United States, 46206-1367; ., Detroit, United States; ., San Raffaele Hospital, 9372, Urology, Via Olgettina, 52, Milano, Italy, 20132; ., University Hospital Careggi, 18561, Department of Oncologic, Minimally-Invasive Urology and Andrology, Largo Brambilla 3, Florence, Toscana, Italy, 50134; ., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100., Seoul, Korea (the Republic of); ., Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of); ., Changzheng Hospital, 56652, Shanghai, Shanghai, China; ., Rome, Italy; ., Istituto Europeo di Oncologia, 9290, Urology , via ripamonti 435, Milano, Italy, 90020., Eiropean Institute of Oncology, Milan, Italy; ., San Diego, United States; ., Virginia Commonwealth University, 6889, 1200 E Broad St, Richmond, Virginia, United States, 23284-2512; ., Los Angeles, United States; ., AOUI Azienda Ospedaliera Universitaria Integrata, Urology, Piazzale Stefani 1, Verona, Italy, 37100; ., Miami, United States; ., Onze Lieve Vrouwziekenhuis, 37467, Dep. of Urology, Aalst, Belgium, 9300; ., Henry Ford Health System, Vattikuti Urology Institute, Center for Outcomes Research Analytics and Evaluation, 2799 West Grand Boulevard, Detroit, Michigan, United States, 48202; ., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134; ., Changhai hospital, the second military medical university, the department of Urology, Changhai Road NO. 163, Shanghai, Shanghai, China, 200433; ., Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144., University of California - San Diego, Urology, La Jolla, California, United States; ., university of Miami, Miller School of Medicine, urology, Miami, Florida, United States; ., UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390; ., Indiana University School of Medicine, Urology, 535 N Barnhill Dr, Suite 420, Indianapolis, Indiana, United States, 46202; ., Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/35019760