Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review

Peyronnet, B.; Seisen, Thomas; Dominguez-Escrig, Jose-Luis; Bruins, Harman Max; Yuan, Yuhong; Lam, Thomas; MacLennan, Steven; N’Dow, James; Babjuk, Marko; Compérat, Éva; Zigeuner, Richard; Sylvester, Richard; Burger, Maximilian; Mostafid, Hugh; Rhijn, Bas W.G. van; Gontero, Paolo; Palou, Joan; Shariat, Shahrokh F.; Rouprêt, Morgan

doi:10.1016/j.euf.2017.10.003

Cited by 122 publications

(98 citation statements)

References 60 publications

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“…The insignificant sex, CIS, BMI, and surgical modality of this study have been indicated as predictive factors for prognosis in other studies . In one study, female sex was associated lower IVRFS after RNU in UTUC (HR 0.812, 95% CI 0.673‐0.981, Table for IVRFS) .…”

Section: Discussionsupporting

confidence: 86%

“…The insignificant sex, CIS, BMI, and surgical modality of this study have been indicated as predictive factors for prognosis in other studies. 3,8,26 In one study, female sex was associated lower IVRFS after RNU in UTUC (HR 0.812, 95% CI 0.673-0.981, Table S1 for IVRFS). 19 However, similar to our results, another study reported no significant association between sex and CSS (HR 1.050, 95% CI 0.841-1.310, Table S1 for OS).…”

Section: Discussionmentioning

confidence: 99%

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Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

et al. 2019

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Background In this study, we aimed to propose a validated prediction model for disease‐free survival (DFS) after radical nephroureterectomy (RNU) in a Korean population with upper urinary tract urothelial carcinoma (UTUC). Methods We performed a retrospective review of 1561 cases of UTUC who underwent either open RNU (ONU, n = 906) or laparoscopic RNU (LNU, n = 615) from five tertiary Korean institutions between January 2000 and December 2012. Data were used to develop a prediction model using the Cox proportional hazards model. Prognostic factors were selected using the backward variable selection method. The prediction model performance was investigated using Harrell's concordance index (C‐index) and Hosmer‐Lemeshow type 2 statistics. Internal validation was performed using a bootstrap approach, and the National Cancer Center data set (n = 128) was used for external validation. Results A best‐fitting prediction model with seven significant factors was developed. The C‐index and two Hosmer‐Lemeshow type statistics of the prediction model were 0.785 (95% CI, 0.755‐0.815), 4.810 ( P = 0.8506), and 5.285 ( P = 0.8088). The optimism‐corrected estimate through the internal validation was 0.774 (95% CI, 0.744‐0.804) and the optimism‐corrected calibration curve was close to the ideal line with mean absolute error = 0.012. In external validation, the discrimination was 0.657 (95% CI, 0.560‐0.755) and the two calibration statistics were 0.790 ( P = 0.9397) and 3.103 ( P = 0.5408), respectively. Conclusion A validated prediction model based on a large Korean RNU cohort was developed with acceptable performance to estimate DFS in patients with UTUC.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

et al. 2019

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“…Minimally invasive surgery is currently widely used in urological oncology. Considerable efforts have been made to ensure the oncological outcomes equivalence between LNU and RANU . No differences were noted in most studies, except in one meta‐analysis that suggested a superiority of ONU for patients with locally advanced high‐risk (pT3/pT4 and/or high‐grade) UTUC .…”

Section: Discussionmentioning

confidence: 99%

“…The standard of care treatment for high‐risk patients is ONU with bladder cuff excision, regardless of the tumor location . However, since its introduction in 1991, LNU has emerged as an alternative to ONU . In more recent years, RANU also had promising perioperative and oncological outcomes .…”

Section: Introductionmentioning

confidence: 99%

Comparison of perioperative outcomes between open and minimally invasive nephroureterectomy: A population‐based analysis

et al. 2019

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Objectives To examine intraoperative and postoperative morbidity and mortality, as well as the impact on length of stay and total hospital charges of minimally invasive nephroureterectomy compared with open nephroureterectomy in patients with upper tract urothelial carcinoma. Methods Within the National Inpatient Sample (2008–2013), we identified patients with non‐metastatic upper tract urothelial carcinoma treated with either minimally invasive nephroureterectomy or open nephroureterectomy. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between open nephroureterectomy versus minimally invasive nephroureterectomy. Multivariable logistic regression, multivariable Poisson regression models and multivariable linear regression models were used. Results Between 2008 and 2013, we identified 3897 patients treated with either minimally invasive nephroureterectomy (1093 [28%]) or open nephroureterectomy (2804 [72%]). In multivariable logistic regression models, minimally invasive nephroureterectomy resulted in lower rates of overall (odds ratio 0.71, P < 0.001), wound (odds ratio 0.49, P = 0.01), intraoperative (odds ratio 0.55, P = 0.01), miscellaneous surgical (odds ratio 0.64, P = 0.008) and miscellaneous medical complications (odds ratio 0.77, P = 0.002). Furthermore, minimally invasive nephroureterectomy was associated with lower rates of transfusions (odds ratio 0.61, P < 0.001). In multivariable Poisson regression models, minimally invasive nephroureterectomy was associated with shorter length of stay (relative risk 0.88, P < 0.001). Finally, higher total hospital charges ($2500 more per patient) were recorded for minimally invasive nephroureterectomy. Conclusions Intraoperative and postoperative morbidity, as well as length of stay, but not total hospital charges favor minimally invasive nephroureterectomy over open nephroureterectomy. These outcomes validate the safety and feasibility of minimally invasive nephroureterectomy in select upper tract urothelial carcinoma patients.

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“…Kido reported that surgical approaches were not independently associated with prognosis in patients with locally advanced UTUCs; however, a systematic review suggested that the outcomes of laparoscopic RNU might be poorer than those of open RNU, particularly when the bladder cuff must be removed. Laparoscopic RNU might also be less effective in patients with locally advanced (pT3/pT4) or high‐grade UTUCs …”

Section: Treatmentmentioning

confidence: 99%

Recent advances in upper tract urothelial carcinomas: From bench to clinics

2018

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Urothelial carcinoma in the upper tract is rare and often discussed separately. Many established risk factors were identified for the disease, including genetic and external risk factors. Radiographic survey, endoscopic examination and urine cytology remained the most important diagnostic modalities. In localized upper tract urothelial carcinomas, radical nephroureterectomy with bladder cuff excision are the gold standard for large, high‐grade and suspected invasive tumors of the renal pelvis and proximal ureter, whereas kidney‐sparing surgeries should be considered in patients with low‐risk disease. Advances in technology have given endoscopic surgery an important role, not only in diagnosis, but also in treatment. Although platinum‐based combination chemotherapy is efficacious in advanced or metastatic disease, current established chemotherapy regimens are toxic and lack a sustained response. Immune checkpoint inhibitors have led to a new era of treatment for advanced or metastatic urothelial carcinomas. The remarkable results achieved thus far show that immunotherapy will likely be the future treatment paradigm. The combination of immune checkpoint inhibitors and other agents is another inspiring avenue to explore that could benefit even more patients. With respect to the high incidence rate and different clinical appearance of upper tract urothelial carcinomas in Taiwan, a possible correlation exists between exposure to certain external risk factors, such as arsenic in drinking water and aristolochic acid in Chinese herbal medicine. As more gene sequencing differences between upper tract urothelial carcinomas and various disease causes are detailed, this has warranted the era of individualized screening and treatment for the disease.

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Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review

Cited by 122 publications

References 60 publications

Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

Comparison of perioperative outcomes between open and minimally invasive nephroureterectomy: A population‐based analysis

Recent advances in upper tract urothelial carcinomas: From bench to clinics

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