The purpose of this study was to evaluate the oncological and perioperative outcomes of robot-assisted bladder cuff excision (RA-BCE) versus open bladder cuff excision (O-BCE) after radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC).
We conducted a multicenter study including all consecutive patients who underwent RA-BCE or O-BCE in eight French academic institutions from 2014 to 2023. Kaplan-Meier curves were used to illustrate survival outcomes, while uni- and multivariable Cox regression analyses were conducted to identify independent predictors of survival by calculating hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs).
Overall, 487 patients underwent either RA-BCE (n = 182; 37.4%) or O-BCE (n = 305; 62.6%). The median follow up was 30.1 (26.9-36) months. Kaplan-Meier analyses showed that the use of RA-BCE versus O-BCE was associated with similar 3-year intravesical recurrence-free survival (RFS) (68.9% vs. 59.7%; p = 0.1), 3-year extravesical RFS (69.2 vs. 63.8%; p = 0.2), 3-year cancer-specific survival (CSS) (85.5% vs. 76.2%; p = 0.08), and 3-year overall survival (OS) (76% vs. 67.6%; p = 0.1). Multivariable Cox regression analyses confirmed that the use of RA-BCE versus O-BCE was associated with similar 3-year intravesical recurrence (HR 0.83; 95% CI 0.55-1.26; p = 0.4), as well as similar 3-year extravesical recurrence (p = 0.8), 3-year CSS (p = 0.3), and 3-year OS (p = 0.3). Among 340 patients (69.8%) assessed, RA-BCE was associated with a lower rate of overall 90-day complications (p = 0.02), fewer major complications (p = 0.02), and a shorter length of stay (p < 0.01).
Our multicenter study supports the effectiveness of RA-BCE versus O-BCE in the treatment of UTUC with comparable 3-year oncological outcomes.
Annals of surgical oncology. 2026 May 11 [Epub ahead of print]
Pierre-Etienne Gabriel, Thomas Seisen, Evanguelos Xylinas, Hugo Duquesne, Gautier Marcq, Igor Duquesne, Anne Sophie Bajeot, Jérémy Mercier, Benjamin Pradère, Louise Duffaut, Frederic Panthier, Yves Allory, François Audenet, Priscilla Leon, Constance Thibault, Morgan Rouprêt, Mathieu Roumiguié, Alexandra Masson-Lecomte
Department of Urology, Université de Paris, APHP, Saint Louis Hospital, Paris, France. ., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, Paris, France., Department of Urology, Bichat Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris Nord, University Paris Cité, Paris, France., Urology Department, Claude Huriez Hospital, CHU Lille, University Lille, CNRS, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, Inserm, France., Department of Urology, Hôpital Cochin, AP-HP, Université de Paris, Paris, France., Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France., UROSUD Urology Department, Clinique Croix Du Sud, Quint-Fonsegrives, France., GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France., Department of Pathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France., Department of Urology, Hôpital Européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France., Urology Department, Clinique Pasteur, Royan, France., Medical Oncology Department, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France., Urology Department, Clinique Pasteur, Toulouse, France., Department of Urology, Université de Paris, APHP, Saint Louis Hospital, Paris, France.