Aim of the study was investigate outcomes of patients affected by locally advanced (pT3-pT4 and/or pN+) upper tract urothelial carcinoma (UTUC) and treated with robot-assisted radical nephroureterectomy (RNU).
Clinical and surgical data of newly-diagnosed UTUC patients referring to 9 high-volume centres from January 2019 to March 2023 undergoing RNU were collected.
191 patients showed locally advanced disease. Da Vinci and Hugo RAS ™ System were employed in 95.8 % and 4.2 % of cases, respectively. Bladder cuff removal was carried out in 161 (84.3 %) patients, by using either an intravesical and extravesical approach in 50 (31.1 %) and 111 (68.9 %) respectively. Open and robotic approaches for bladder cuff removal were preferred in 107 (66.5 %) and 54 (33.5 %) patients, respectively. Lymph node dissection was performed in 55 % of patients. Median follow up was 19 (IQR 10-23) months and 31 (16.4 %) patients experienced bladder recurrence. On multivariate analysis, in those patients receiving RNU and bladder cuff removal, the approach for bladder cuff management (extravesical vs intravesical) was the only independent predictor of bladder recurrence (hazard ratio [HR]: 1.34; 95 % confidence interval [CI] 1.12-2.11; p = 0.03). Surgical approach for bladder cuff management (open vs robot) was not independently associated with bladder recurrence or tumor progression (both p > 0.05) CONCLUSIONS: In experienced hands, the robotic approach showed satisfactory survival outcomes also for the surgical treatment of pathological locally advanced UTUC. Extravesical approach for bladder cuff management may be burdened by a higher risk for bladder recurrence in locally advanced disease.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2025 Aug 21 [Epub ahead of print]
Fabrizio Di Maida, Carlo Andrea Bravi, Ruben De Groote, Federico Piramide, Filippo Turri, Mike Wenzel, Gopal Sharma, Christoph Würnschimmel, Iulia Andras, Edward Lambert, Paolo Dell'Oglio, Marcio Covas Moschovas, Riccardo Campi, Antonio Andrea Grosso, Nikolaos Liakos, Roman Mayr, Andrea Mari, Danny Darlington Carbin Joseph, Ahmed Eraky, Marco Paciotti, Gabriele Sorce, Stefano Tappero, Francesco Montorsi, Alberto Briganti, Alexandre Mottrie, Andrea Minervini, Alberto Breda, Alessandro Larcher, Junior ERUS/EAU-YAU Working Group on Robot-assisted Surgery
Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy. Electronic address: ., Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Urology, Northampton General Hospital, Northampton, UK; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium., Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy., Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy., Department of Urology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany., Department of Urologic Oncology, Medanta the Medicity, Gurgaon, India., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium., ASST Grande Ospedale Metropolitano Niguarda Urology Department, Milan, Italy., AdventHealth Global Robotics Institute, Celebration, FL, USA., Department of Experimental and Clinical Medicine, University of Florence - Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy., Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy., Department of Urology, Faculty of Medicine, Medical Centre of the University of Freiburg, Freiburg, Germany., Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany., Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy., Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40850212