Comparison of survival outcomes between laparoscopic versus open radical nephroureterectomy in upper tract urothelial cancer patients: Experiences of a tertiary care single center

Benedikt Hoeh; Marina Kosiba; Mike Wenzel; Nicola Meister; Felix Preisser; Shahrokh F Shariat; Jan Lukas Hohenhorst; Andreas Becker; Philipp Mandel; Severine Banek; Frederik Roos; Pierre I Karakiewicz; Felix K H Chun; Luis A Kluth

doi:10.1097/CU9.0000000000000113

Comparison of survival outcomes between laparoscopic versus open radical nephroureterectomy in upper tract urothelial cancer patients: Experiences of a tertiary care single center

Curr Urol. 2023 Dec;17(4):292-298. doi: 10.1097/CU9.0000000000000113. Epub 2022 Aug 31.

Authors

Benedikt Hoeh^{1

2}, Marina Kosiba¹, Mike Wenzel¹, Nicola Meister¹, Felix Preisser¹, Shahrokh F Shariat^{3

4

5

6

7

8}, Jan Lukas Hohenhorst^{2

9}, Andreas Becker¹, Philipp Mandel¹, Severine Banek¹, Frederik Roos¹, Pierre I Karakiewicz², Felix K H Chun¹, Luis A Kluth¹

Affiliations

¹ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
³ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
⁴ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
⁵ Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
⁶ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
⁷ Institute for Urology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
⁸ Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁹ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Objectives: To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Materials and methods: We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database. Patients undergoing laparoscopic or open RNU with no suspicion of metastasis (cM0) were for the current study population. Patients with suspected metastases at diagnosis (cM1) or those undergoing other surgical treatments were excluded. Tabulation was performed according to the laparoscopic versus open surgical approach. Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach. Furthermore, separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.

Results: Of the 59 patients who underwent nephroureterectomy, 29% (n = 17) underwent laparoscopic nephroureterectomy, whereas 71% (n = 42) underwent open nephroureterectomy. Patient and tumor characteristics were comparable between groups (p ≥ 0.2). The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group (p = 0.5), respectively. The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies (73 months for both groups; p = 0.9). Furthermore, the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.

Conclusions: The results of this retrospective, single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU. Furthermore, preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.

Keywords: Laparoscopic radical nephroureterectomy; Open radical nephroureterectomy; Overall survival; Upper tract urothelial carcinoma.