Cancer Res Treat.  2019 Jan;51(1):240-251. 10.4143/crt.2017.417.

The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study

• Kim TH
• Hong B
• Seo HK
• Kang SH
• Ku JH
• Jeong BC

• KMID: 2437616
• DOI: http://doi.org/10.4143/crt.2017.417

Abstract

PURPOSE
We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU).
MATERIALS AND METHODS
Consecutive cases of ONU and LNU between 2000 and 2012 at five participating institutions were included in this retrospective analysis. Clinical characteristics and pathologic outcomes were compared between the two surgical approaches. The influence of the type of surgical approach on intravesical recurrence-free survival (IVRFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan-Meier method and differences were assessed with the log-rank test. Predictors of IVRFS, PFS, CSS, and OS were also analyzed with a multivariable Cox regression model.
RESULTS
A total of 1,521 patients with UTUC were eligible for the present study (ONU, 906; LNU, 615). The estimated 5-year IVRFS (57.8 vs. 51.0%, p=0.010), CSS (80.4 vs. 76.4%, p=0.032), and OS (75.8 vs. 71.4%, p=0.026) rates were significantly different between the two groups in favor of LNU. Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. Multivariable Cox regression analyses showed that type of surgical approach was independently associated with IVRFS, but was not related to PFS, CSS, and OS.
CONCLUSION
Our findings indicate that LNU provided better oncologic control of IVRFS, CSS, and OS compared with ONU for the management of patients with UTUC.

Keyword

Transitional cell cancer; Laparoscopy; Malignant disease; Survival

MeSH Terms

Disease-Free Survival
Humans
Laparoscopy
Methods
Retrospective Studies

Figure

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  Fig. 1. Cumulative survival of 1,521 patients after radical nephroureterectomy for upper tract urothelial carcinoma, stratified by surgical approach. (A) Intravesical recurrence-free survival. (B) Progression-free survival. (C) Cancer-specific survival. (D) Overall survival. LNU, laparoscopic nephroureterectomy; ONU, open nephroureterectomy.

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  Fig. 2. Cumulative survival of 894 patients with organ-confined disease (pTis/pTa/pT1/T2) after radical nephroureterectomy for upper tract urothelial carcinoma, stratified by surgical approach. (A) Intravesical recurrence-free survival. (B) Progression-free survival. (C) Cancer-specific survival. (D) Overall survival. LNU, laparoscopic nephroureterectomy; ONU, open nephroureterectomy.

• 

  Fig. 3. Cumulative survival of 627 patients with locally advanced disease (pT3/pT4) after radical nephroureterectomy for upper tract urothelial carcinoma, stratified by surgical approach. (A) Intravesical recurrence-free survival. (B) Progressionfree survival. (C) Cancer-specific survival. (D) Overall survival. LNU, laparoscopic nephroureterectomy; ONU, open nephroureterectomy

Reference

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