Oncologic outcomes for open and laparoscopic radical nephroureterectomy in patients with upper tract urothelial carcinoma
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Oncologic benefits of laparoscopic radical nephroureterectomy (LNU) are unclear. We aimed to evaluate the impact of surgical approach for radical nephroureterectomy on oncologic outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC).
Of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017, we retrospectively investigated oncological outcomes in 229 with locally advanced UTUC (stages cT3-4 and/or cN+). The surgical approach was classified as open nephroureterectomy (ONU) or LNU, and oncologic outcomes, including intravesical recurrence-free survival (RFS), visceral RFS, cancer-specific survival (CSS), and overall survival (OS), were compared between the groups. The inverse probability of treatment weighting (IPTW)-adjusted Cox-regression analyses was performed to evaluate the impact of LNU on the prognosis.
Of the 229 patients, 48 (21%) underwent LNU. There were significant differences in patient backgrounds, including preoperative renal function, lymph-node involvement, lymphovascular invasion, and surgical margins, between the groups. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS were significantly inferior in the ONU group than in the LNU group. However, in the IPTW-adjusted Cox-regression analysis, no significant differences were observed in intravesical RFS (hazard ratio [HR], 0.65; P = 0.476), visceral RFS (HR, 0.46; P = 0.109), CSS (HR, 0.48; P = 0.233), and OS (HR, 0.40; P = 0.147).
Surgical approaches were not independently associated with prognosis in patients with locally advanced UTUC.
KeywordsUpper tract urothelial carcinoma Radical nephroureterectomy Laparoscopic Oncologic outcome
Upper tract urothelial carcinoma
Open radical nephroureterectomy
Laparoscopic radical nephroureterectomy
Inverse probability of treatment weighting
Eastern Cooperative Oncology Group performance status
Estimated glomerular filtration rate
Chronic kidney disease
The authors would like to thank Hiroyuki Ito, Kazuaki Yoshikawa, Atsushi Sasaki, Hiromichi Iwamura, Ken Fukushi, Jotaro Mikami, Takuma Narita, Toshikazu Tanaka, Itsuto Hamano, Yuki Fujita, Yukie Nishizawa, Satomi Sakamoto, and Yuriko Tanabe for their invaluable help with data collection. The authors would also like to thank Enago (www.enago.jp) for the English language review.
Conception and design: Shingo Hatakeyama. Acquisition of data: Koichi Kido, Naoki Fujita, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Ikuya Iwabuchi, Masaru Ogasawara, Toshiaki Kawaguchi. Analysis and interpretation of data: Shingo Hatakeyama, Yuki Tobisawa, Tohru Yoneyama. Drafting of the manuscript: Koichi Kido, Shingo Hatakeyama. Critical revision of the manuscript: Naoki Fujita, Takuya Koie, Chikara Ohyama. Statistical analysis: Shingo Hatakeyama, Tohru Yoneyama. Obtaining funding: Shingo Hatakeyama, Takuya Koie, Chikara Ohyama. Administrative, technical, or material support: Yuki Tobisawa, Tohru Yoneyama
Compliance with ethical standards
Conflict of interests
The authors declare no conflicts of interest.
This work was supported by a Grant-in-Aid for Scientific Research (No. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, and 17K16771) from the Japan Society for the Promotion of Science.
This study was performed in accordance with the ethical standards of the Declaration of Helsinki and approved by an ethics review board of Hirosaki University School of Medicine (authorization numbers; 2017–089) and all other hospitals.
For this type of study, formal written consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation. The study information was open for the public consumption at http://www.med.hirosaki-u.ac.jp/~uro/html/IRB/IRBdoc.html.
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