Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database

Chih-Chun Kuo; Guang-Heng Chen; Chao-Hsiang Chang; Chao-Yuan Huang; Chung-Hsin Chen; Ching-Chia Li; Wen-Jeng Wu; Chih-Chin Yu; Chi-Wen Lo; Yung-Tai Chen; Shin-Hong Chen; Pai-Yu Cheng; Thomas Y Hsueh; Allen W Chiu; Po-Han Lin; Jen-Shu Tseng; Jen-Tai Lin; Yuan-Hong Jiang; Chia-Chang Wu; Wei-Yu Lin; Hsu-Che Huang; Han-Sun Chiang; Bing-Juin Chiang

doi:10.3389/fsurg.2022.934355

Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database

Front Surg. 2022 Sep 1:9:934355. doi: 10.3389/fsurg.2022.934355. eCollection 2022.

Authors

Chih-Chun Kuo^{1

2}, Guang-Heng Chen^{3

4}, Chao-Hsiang Chang^{3

5}, Chao-Yuan Huang², Chung-Hsin Chen², Ching-Chia Li^{6

7

8}, Wen-Jeng Wu^{6

7

8}, Chih-Chin Yu^{9

10}, Chi-Wen Lo⁹, Yung-Tai Chen¹¹, Shin-Hong Chen¹¹, Pai-Yu Cheng¹², Thomas Y Hsueh^{13

14}, Allen W Chiu¹⁵, Po-Han Lin⁹, Jen-Shu Tseng^{16

17

18}, Jen-Tai Lin¹⁹, Yuan-Hong Jiang²⁰, Chia-Chang Wu^{21

22

23}, Wei-Yu Lin^{24

25

26}, Hsu-Che Huang^{1

27}, Han-Sun Chiang^{1

28}, Bing-Juin Chiang^{1

27

29}

Affiliations

¹ Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
² Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
⁴ Department of Urology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
⁵ School of Medicine, China Medical University, Taichung, Taiwan.
⁶ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁷ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁹ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁰ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹¹ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
¹² Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan.
¹³ Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan.
¹⁴ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁵ College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁶ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁷ Mackay Medical College, Taipei, Taiwan.
¹⁸ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁹ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
²⁰ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
²¹ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
²² Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
²³ TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan.
²⁴ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
²⁵ Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
²⁶ Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
²⁷ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
²⁸ Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
²⁹ School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.

Abstract

Purpose: Taiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.

Materials and methods: The nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.

Results: Of the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.

Conclusion: Although different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.

Keywords: hand-assisted laparoscopic nephroureterectomy; laparoscopic nephroureterectomy; oncological outcome; surgical volume; upper urinary tract urothelial carcinoma; urothelial carcinoma.