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Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma

World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in upper urinary tract urothelial carcinoma (UTUC) patients.

Methods

We retrospectively analyzed the data of 371 UTUC patients who underwent ORNU (n = 271) or LRNU (n = 100) between 1992 and 2012. The survival outcomes included intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS). The Kaplan–Meier method and log-rank test were used to estimate and compare survival curves between groups. Factors associated with survival outcomes were evaluated using univariable and multivariable Cox proportional hazard models.

Results

The three-year IVR-free survival rates were similar between the ORNU and LRNU groups (59.9 and 61.7 %, p = 0.267). However, the LRNU group showed worse five-year OS (59.1 vs. 75.2 %, p = 0.027) and CSS (66.1 vs. 80.2 %, p = 0.015) rates than the ORNU group. In particular, on stratifying the study cohort by pathological stages, significant differences in OS (p = 0.007) and CSS (p = 0.005) between the surgical approaches were observed only in locally advanced disease (pT3/T4). In multivariable analysis, LRNU was an independent predictor of worse OS (p = 0.001) and CSS (p = 0.006) than ORNU. Likewise, in multivariable analysis in patients with pT3/T4 stage, LRNU was significantly associated with worse OS (hazard ratio [HR] 2.59, p = 0.001) and CSS (HR 2.50, p = 0.005).

Conclusions

Our data suggest that in UTUC patients, LRNU, compared to ORNU, is generally associated with unfavorable OS and CSS results. In particular, LRNU should be performed in locally advanced UTUC patients after careful consideration of its impact on patient survival.

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Acknowledgments

No grants or other external funding sources were used for this study.

Author contributions

Hyung Suk Kim, Ja Hyeon Ku, Chang Wook Jeong, and Hyeon Hoe Kim involved in conception and design. Hyung Suk Kim, Ja Hyeon Ku, and Hyeon Hoe Kim are responsible for data acquisition. Hyung Suk Kim involved in data analysis and interpretation. Hyung Suk Kim involved in manuscript drafting. Hyeon Hoe Kim is responsible for critical revision of the manuscript for scientific and factual content. Hyung Suk Kim involved in statistical analysis. Hyeon Hoe Kim involved in supervision.

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Authors and Affiliations

  1. Department of Urology, Seoul National University College of Medicine, Seoul, Korea

    Hyung Suk Kim, Ja Hyeon Ku, Chang Wook Jeong, Cheol Kwak & Hyeon Hoe Kim

  2. Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Hyeon Hoe Kim

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  1. Hyung Suk Kim
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Correspondence to Hyeon Hoe Kim.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval for the study

The study design and use of patient information stored in the hospital database were approved by the Institutional Review Board (IRB) of the Seoul National University Hospital. The approval number is H-1506-100-681. This study was exempt from informed consent requirements by the IRB because this was a retrospective study, and personal identifiers were completely removed and data were analyzed anonymously. This study was conducted according to the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Supplementary material 1 (DOCX 21 kb)

345_2015_1712_MOESM2_ESM.tif

Supplementary material 2 Fig. 1. Kaplan–Meier curves for intravesical recurrence-free survival in subgroups stratified by pathologic tumor (pT) stages, according to the mode of surgery. ORNU, open radical nephroureterectomy; LRNU, laparoscopic radical nephroureterectomy (TIFF 926 kb)

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Kim, H.S., Ku, J.H., Jeong, C.W. et al. Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol 34, 859–869 (2016). https://doi.org/10.1007/s00345-015-1712-3

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  • DOI: https://doi.org/10.1007/s00345-015-1712-3

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