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Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset.

Methods

Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes.

Results

Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR.

Conclusion

Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Keisuke Shigeta MD, Kazuhiro Matsumoto MD, PhD, Toshikazu Takeda MD, PhD, Nobuyuki Tanaka MD, PhD, Ryuichi Mizuno MD, PhD, Hiroshi Asanuma MD, PhD & Mototsugu Oya MD, PhD

  2. Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan

    Seiya Hattori MD

  3. Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan

    Gou Kaneko MD, PhD

  4. Department of Urology, Ogikubo Hospital, Tokyo, Japan

    Masashi Matsushima MD, PhD

  5. Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan

    Takayuki Abe PhD

  6. Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan

    Eiji Kikuchi MD, PhD

Authors
  1. Keisuke Shigeta MD
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  2. Kazuhiro Matsumoto MD, PhD
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  3. Toshikazu Takeda MD, PhD
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  4. Seiya Hattori MD
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  8. Nobuyuki Tanaka MD, PhD
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  9. Ryuichi Mizuno MD, PhD
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  12. Mototsugu Oya MD, PhD
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Correspondence to Kazuhiro Matsumoto MD, PhD.

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Shigeta, K., Matsumoto, K., Takeda, T. et al. Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching. Ann Surg Oncol 28, 465–473 (2021). https://doi.org/10.1245/s10434-020-09046-9

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  • DOI: https://doi.org/10.1245/s10434-020-09046-9

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