Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

Ching-Chia Li; Chao-Hsiang Chang; Chi-Ping Huang; Jian-Hua Hong; Chao-Yuan Huang; I-Hsuan Alan Chen; Jen-Tai Lin; Chi-Wen Lo; Chih-Chin Yu; Jen-Shu Tseng; Wun-Rong Lin; Wei-Che Wu; Shiu-Dong Chung; Thomas Y Hsueh; Allen W Chiu; Yung-Tai Chen; Shin-Hong Chen; Yuan-Hong Jiang; Yao-Chou Tsai; Bing-Juin Chiang; Wei Yu Lin; Yeong-Chin Jou; Chia-Chang Wu; Hsiang-Ying Lee; Hsin-Chih Yeh

doi:10.3389/fonc.2021.731460

Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

Front Oncol. 2021 Oct 4:11:731460. doi: 10.3389/fonc.2021.731460. eCollection 2021.

Authors

Ching-Chia Li^{1

2

3}, Chao-Hsiang Chang^{4

5}, Chi-Ping Huang^{4

5}, Jian-Hua Hong^{6

7}, Chao-Yuan Huang⁶, I-Hsuan Alan Chen⁸, Jen-Tai Lin⁸, Chi-Wen Lo⁹, Chih-Chin Yu^{9

10}, Jen-Shu Tseng^{11

12

13}, Wun-Rong Lin^{11

12}, Wei-Che Wu^{7

14}, Shiu-Dong Chung^{14

15}, Thomas Y Hsueh^{16

17}, Allen W Chiu¹⁸, Yung-Tai Chen¹⁹, Shin-Hong Chen¹⁹, Yuan-Hong Jiang²⁰, Yao-Chou Tsai^{21

22}, Bing-Juin Chiang^{23

24

25}, Wei Yu Lin^{26

27

28}, Yeong-Chin Jou^{29

30}, Chia-Chang Wu^{31

21

32}, Hsiang-Ying Lee^{1

2

33

34}, Hsin-Chih Yeh^{1

2

3

33}

Affiliations

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
⁵ School of Medicine, China Medical University, Taichung, Taiwan.
⁶ Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
⁸ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁹ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.
¹⁰ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹¹ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
¹² Department of Urology, Mackay Medical College, New Taipei City, Taiwan.
¹³ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁴ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁵ Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan.
¹⁶ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.
¹⁷ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁸ College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁹ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
²⁰ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
²¹ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
²² Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan.
²³ College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
²⁴ Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
²⁵ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
²⁶ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
²⁷ Chang Gung University of Science and Technology, Chiayi, Taiwan.
²⁸ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
²⁹ Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
³⁰ Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan.
³¹ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³² TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³³ Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
³⁴ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Purpose: This study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy.

Methods: From the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches.

Results: Among the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001).

Conclusions: Minimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.

Keywords: hand-assisted; laparoscopic; nephroureterectomy; robotic; upper tract urothelial carcinoma.