Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes

Abstract

The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient’s overall health, and very importantly, the surgeon’s skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.

Adoption of robot-assisted radical nephroureterectomy permits a minimally invasive option for management of upper tract urothelial carcinoma in geriatric patients: comparison with non-geriatric patients with intermediate-term oncologic follow-up

“…The differences in OS were in line with prior studies, thus validating the importance in counseling patients of advanced age regarding preoperative optimization and proper patient selection [ 14 ]. Advances in surgical techniques for RARNU, such as complete retroperitoneal access and use of single-port system, as well as the use of NAC, may improve oncologic parameters and decrease perioperative complications in this age group; however, further studies are needed [ 16 ].…”

“…A multidimensional geriatric assessment should be considered to determine surgical candidates [14]. RARNU can expand the role of surgical resection for those who may have an increased risk of perioperative complications, such as geriatric patient [15][16][17]. Furthermore, RARNU has demonstrated similar oncological efficacy to open and laparoscopic approaches for UTUC management [15,18,19].…”

A Comprehensive Review on Upper Tract Urothelial Carcinoma: An Update in 2023

“…During the recent two decades, there has been a major shift from open RNU towards minimally invasive techniques. Franco et al presented the latest evidence regarding surgical techniques and outcomes of minimally invasive RNU, focusing on robotic RNU [5]. The authors reviewed novel robotic techniques, including single-stage transperitoneal, retroperitoneal, and single-port RNUs.…”