Is Robotic Superior to Laparoscopic Approach for Radical Nephroureterectomy with Bladder Cuff Excision in Treating Upper Urinary Tract Urothelial Carcinoma?

Huang, Yu Pin; Huang, Eric Yi-Hsiu; Chung, Hsiao-Jen; Tai, Meng-Che; Huang, Tzu-Hao; Wei, Tony Tzu-Chun; Fan, Yu‐Hua; Lin, Chih-Chieh; Lin, Tao; Kuo, Junne-Yih; Lu, Shing-Hwa; Chang, Yen-Hwa; Lin, Alex Tong‐Long; Huang, William J.S.

doi:10.1089/end.2022.0154

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…We retrieved a total of 26 references for a comprehensive full-text evaluation. A total of 15 studies met the inclusion criteria of this review [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The study by Mourmouris et al [22] was the only one that was reported as a prospective study from two institutions.…”

Section: Resultsmentioning

confidence: 99%

Oncological Efficacy of Robotic Nephroureterectomy vs. Open and Laparoscopic Nephroureterectomy for Suspected Non-Metastatic UTUC—A Systematic Review and Meta-Analysis

Rajan,

Khalifa,

Geraghty

et al. 2023

Cancers

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Introduction and Aims: The optimal approach for nephroureterectomy in patients with suspected UTUC remains a point of debate. In this review, we compare the oncological outcomes of robotic nephroureterectomy (RNU) with open (ONU) or laparoscopic nephroureterectomy (LNU). Methods: All randomized trials and observational studies comparing RNU with ONU and/or LNU for suspected non-metastatic UTUC are included in this review. The systematic review was performed in accordance with the Cochrane Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IV-RFS). The secondary outcome measures were the lymph node dissection (LND) rates, positive margin rates, and the proportion of patients receiving bladder intravesical chemotherapy. Results: We identified 8172 references through our electronic searches and 8 studies through manual searching. A total of 15 studies met the inclusion criteria. The total number of patients in the review was 18,964. RNU had superior OS compared to LNU (HR: 0.81 (95% CI: 0.71, 0.93), p-0.002 (very low certainty)). RNU and ONU had similar OS (HR: 0.83 (95% CI: 0.52, 1.34), p-0.44 (very low certainty)). One study reported an independent association of RNU as a worse predictor of IV-RFS when compared to ONU (HR-1.73 (95% CI: 1.22, 2.45)). The LND rates were higher in the RNU cohort when compared to the LNU cohort (RR 1.24 (95% CI: 1.03, 1.51), p-0.03 (low certainty)). The positive margin rate was lower in the RNU cohort when compared to the ONU cohort (RR 0.29 (95% CI: 0.08, 0.86), p-0.03 (low certainty)). Conclusion: RNU offers comparable oncological efficacy to ONU, except for intravesical recurrence-free survival (IV-RFS). RNU has fewer positive surgical margin rates compared to ONU in well-balanced studies. RNU appears to outperform LNU for certain oncological parameters, such as OS and the proportion of patients who receive lymph node dissections. The quality of evidence comparing surgical techniques for UTUC has remained poor in the last decade.

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Section: Resultsmentioning

confidence: 99%

Oncological Efficacy of Robotic Nephroureterectomy vs. Open and Laparoscopic Nephroureterectomy for Suspected Non-Metastatic UTUC—A Systematic Review and Meta-Analysis

Rajan,

Khalifa,

Geraghty

et al. 2023

Cancers

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“…In a most recent study comparing LNU vs. RAL-NU, Huang et al ( 83 ) conducted an observational retrospective study involving a total 231 patients. They found similar perioperative and oncological outcomes but superiority of RAL-NU in terms of LOS and intraoperative blood loss.…”

Section: Current Evidencementioning

confidence: 99%

Robotic nephroureterectomy supplanting open and laparoscopic approach for upper tract urothelial carcinoma management: a narrative review

Zuluaga,

Rich,

Razdan

et al. 2023

Transl Androl Urol

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Background and Objective The use of robotic surgery for managing upper tract urothelial carcinoma (UTUC) has increased significantly over the years. Minimally invasive techniques (MIS) are now used for approximately half of all robot-assisted laparoscopic nephroureterectomy (RAL-NU) performed in the USA. However, there are currently no specific management guidelines that recommend the use of a robotic approach, and the available literature on this topic is limited. For this reason, we reviewed the history and current literature regarding this technique. Methods We searched Web of Science and PubMed for articles between 1934 to 2023 using 20 different search terms and combinations. We restricted our selection to only publications in English language. Key Content and Findings Comparative retrospective studies between techniques [open nephroureterectomy (ONU), laparoscopic nephroureterectomy (LNU), and RAL-NU] and case series of surgical groups, mostly at short- and mid-term follow-up, were included. Conclusions Robotic surgery for UTUC is on the rise and is predicted to become the preferred method for nephroureterectomy. A comparison of RAL-NU to LNU and ONU shows several advantages, including less blood loss, pain, and hospital stay, as well as a quicker recovery time. The safety and effectiveness of robotic surgery for lymphadenectomy also supports its use in RAL-NU. As more medical facilities adopt the technique and further studies support its benefits, it is likely that robotic surgery will become the preferred method for NU.

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“…While robotic-assisted laparoscopic technique may have some advantages over tRNU, TRNU or ONU, including less blood loss and higher success rates, it is associated with higher costs and no advantages in some aspects such as mortality, operative time, recurrence, distant metastasis, and overall survival. [9][10][11] Therefore, laparoscopic techniques, including remain important and commonly performed in hospitals. In the current meta-analysis, our results indicate that CRNU has advantages over TRNU, suggesting that CRNU may have an important position in laparoscopic techniques.…”

Section: First Author Surgerymentioning

confidence: 99%

“…Similarly, the robotic-assisted laparoscopic technique also faces the same challenges as the total tRNU, despite its potential as a game changer. [9][10][11] Moreover, the transperitoneal approach has been shown to have poorer outcomes than the retroperitoneal approach. [12] Therefore, there is a need for a completely retroperitoneoscopic nephroureterectomy (CRNU) technique.…”

Section: This Study Was Funded By the Science And Technology Program ...mentioning

confidence: 99%

Systematic review and meta-analysis of completely retroperitoneoscopic nephroureterectomy versus traditional retroperitoneoscopic nephroureterectomy in upper tract urothelial carcinoma

Zhao

Yin

et al. 2023

Medicine

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Background: This systematic review and meta-analysis aim to evaluate the efficacy and safety of completely retroperitoneoscopic nephroureterectomy (CRNU) for the treatment of upper urinary tract urothelial carcinoma (UTUC).Methods: A systematic review of PubMed and Web of Science databases was conducted to identify trials comparing the outcomes of CRNU and other surgical procedures. A total of 6 case-control studies were selected for analysis. The efficacy and safety of CRNU were evaluated using mean difference or hazard ratio (HR) with 95% CIs, employing continuous or dichotomous method with a random or fixed-effect model. Meta-analysis was performed using STATA 11.0 software. Results:The meta-analysis indicated that CRNU in subjects with UTUC was significantly associated with a shorter operation time (standardized mean difference, −1.36; 95% CI, −1.61 to −1.11, P < .001) and lower blood loss (standardized mean difference, −0.54; 95% CI, −0.77 to −0.31, P < .001) when compared to traditionally retroperitoneoscopic nephroureterectomy (TRNU). No significant difference was observed in the occurrence of grade I & II complications (HR, 1.04; 95% CI, 0.49-2.2, P = .915) and total complications (HR, 0.69; 95% CI, 0.38-1.27, P = .238) between CRNU and TRNU. Conclusion:The findings suggest that CRNU is an advanced surgical technique that is safe and effective for the treatment of UTUC. We recommend that CRNU be further employed for patients with UTUC. Further randomized, multicenter trials are needed to validate these results, given the limitations of this study.

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Is Robotic Superior to Laparoscopic Approach for Radical Nephroureterectomy with Bladder Cuff Excision in Treating Upper Urinary Tract Urothelial Carcinoma?

Cited by 11 publications

References 21 publications

Oncological Efficacy of Robotic Nephroureterectomy vs. Open and Laparoscopic Nephroureterectomy for Suspected Non-Metastatic UTUC—A Systematic Review and Meta-Analysis

Oncological Efficacy of Robotic Nephroureterectomy vs. Open and Laparoscopic Nephroureterectomy for Suspected Non-Metastatic UTUC—A Systematic Review and Meta-Analysis

Robotic nephroureterectomy supplanting open and laparoscopic approach for upper tract urothelial carcinoma management: a narrative review

Systematic review and meta-analysis of completely retroperitoneoscopic nephroureterectomy versus traditional retroperitoneoscopic nephroureterectomy in upper tract urothelial carcinoma

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