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Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions

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Abstract

Robot-Assisted NephroUreterectomy (RANU) represents a minimally invasive alternative to open NephroUreterectomy (NU) for management of Upper Tract Urothelial Carcinoma (UTUC) but its oncologic safety is still controversial. The objective of this study was to investigate the peri-operative, pathologic and oncologic outcomes of RANU for UTUC. From 2008 to 2017, 78 patients diagnosed with UTUC and elected for RANU at 3 high-volume robotic surgery centres were retrospectively assessed. Surgery was performed using da Vinci Si® and Xi® systems. RANU was done adhering to oncological principles as in open surgery. The outcomes of the study were: (1) peri-operative morbidity, namely intra- and post-operative complications, blood loss, length of hospital stay and operative time; (2) oncologic outcomes, namely overall survival (OS) and recurrence-free survival (RFS). Peri-operative overall complication rate was 24.4% and high-grade complication rate was 2.6%. Median blood loss, length of hospital stay and operative time were 124 ml, 4 days and 167 min. Lymphadenectomy was performed in 31 (41%) patients. Lymph-node involvement was present in 9 (29%) patients. At median follow-up of 15 months, 2- and 4-year OS were 79% and 66%, respectively, and RFS was 63% and 53%. Peritoneal dissemination was recorded in 1 (1.3%) patient with pT4N2R1 UTUC. Our study is limited by the relatively small cohort of patients and its retrospective character. RANU as minimally invasive treatment for patients with UTUC is safe and feasible. Post-operative morbidity is low and major complications are rare. Oncologic outcomes are acceptable and no evidence of increased risk of peritoneal dissemination is recorded. Long-term data are needed. RANU should be regarded as an alternative to open surgery for UTUC that can offer good peri-operative and oncologic results.

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Acknowledgements

The members of the YAU Robotic and Urothelial group are: G. De Naeyer, A. Larcher, J. M. Gaya Sopena, G. Pini, N. Grivas, A. Wallerstedt Lantz, W. L. M. Everaerts, S. Goonewardene, A. Ploumidis. See also this link: https://uroweb.org/education/young-urologists-office-yuo/yau/robotics/.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium

    Ruben De Groote, Alessandro Larcher, Frederiek D’Hondt, Peter Schatteman, Alexandreμ Mottrie & Geert De Naeyer

  2. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Ruben De Groote, Karel Decaestecker, Sarah Buelens, Elise De Bleser & Nicolaas Lumen

  3. ORSI Academy, Melle, Belgium

    Alessandro Larcher & Alexandreμ Mottrie

  4. Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Alessandro Larcher & Francesco Montorsi

Authors
  1. Ruben De Groote
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  2. Karel Decaestecker
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  3. Alessandro Larcher
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  4. Sarah Buelens
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  6. Frederiek D’Hondt
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  7. Peter Schatteman
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  11. Geert De Naeyer
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Consortia

the YAU Robotic and Urothelial Group

  • G. De Naeyer
  • , A. Larcher
  • , J. M. Gaya Sopena
  • , G. Pini
  • , N. Grivas
  • , A. Wallerstedt Lantz
  • ,  W. L. M. Everaerts
  • , S. Goonewardene
  •  & A. Ploumidis

Contributions

The authors declare that they have contributed to the article as stated below: RDG, KD, and GDN: protocol/project development, manuscript writing/editing, data collection or management. AL: manuscript writing/editing, data collection or management, data analysis. SB and EDB: data analysis. FDH, NL, FM, AM: protocol/project development. PS: manuscript writing/editing.

Corresponding author

Correspondence to Ruben De Groote.

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Conflict of interest

All authors declare that they have no conflicts of interest in preparing this article.

Ethical approval

The authors declare to have received ethical approval from the local ethical committee at Onze Lieve Vrouw Hospital Aalst, Belgium for this research involving human participants. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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The members of the YAU Robotic and Urothelial Group listed in Acknowlegements.

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De Groote, R., Decaestecker, K., Larcher, A. et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions. J Robotic Surg 14, 211–219 (2020). https://doi.org/10.1007/s11701-019-00965-8

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  • DOI: https://doi.org/10.1007/s11701-019-00965-8

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