Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

Abstract

Background The debate on whether to choose a transperitoneal (TP) or retroperitoneal (RP) approach for treating upper urinary tract urothelial carcinoma (UTUC) with laparoscopic surgery has been drawing attention. This study aimed to systematically review and meta-analyze the existing evidence regarding oncologic and perioperative outcomes of transperitoneal laparoscopic radical nephroureterectomy (TLNU) and retroperitoneal laparoscopic radical nephroureterectomy (RLNU) in managing UTUC. Methods A comprehensive literature search was conducted using PubMed, Scopus, Embase, and Google Scholar for identifying randomized controlled trials (RCTs) and observational studies that evaluated the outcomes of TLNU and RLNU for UTUC. Continuous variables were represented by weighted mean difference (WMD) and standard mean difference (SMD), while binary variables were represented by odds ratio (OR), with 95% confidence intervals (CIs). The quality was assessed using the Newcastle–Ottawa scale. A sensitivity analysis was performed to evaluate the robustness of the estimates. Result Six observational studies were incorporated into this meta-analysis. The overall TLNU was associated with significantly shorter operating time (WMD − 19.85; 95% CI − 38.03 to − 1.68; P = 0.03); longer recovery time of intestinal function (SMD 0.46; 95% CI 0.08 to 0.84; P = 0.02). However, the terms of estimated blood loss (WMD − 5.72; 95% CI − 19.6 to − 8.15; P = 0.42); length of stay (WMD − 0.35; 95% CI − 1.61 to 0.91; P = 0.59), visual analog pain scale (WMD − 0.38; 95% CI − 0.99 to 0.84; P = 0.22); drainage duration (WMD − 0.22; 95% CI − 0.61 to 0.17; P = 0.26); overall complication rates (OR 1.24; 95% CI 0.58 to 2.63; P = 0.58); local recurrence rate (OR 0.6; 95% CI 0.3 to 1.21; P = 0.16); distant metastasis (OR 0.94; 95% CI 0.04 to 20.77; P = 0.97); 1-year overall survival (OS) (OR 0.45; 95% CI 0.1 to 2.01; P = 0.3) showed no difference between TLNU and RLUN. Conclusion TLNU provides similar surgical outcomes and oncologic results compared to RLUN; however, TLNU has a shorter procedure time and prolonged intestinal function recovery time. Due to the heterogeneity among the studies, randomized clinical trials with follow-ups in the long term are required to obtain more definite results. Trial registration www.crd.york.ac.uk/prospero/, identifier CRD42023388554.

Comparison of Oncological Outcomes between Transperitoneal and Retroperitoneal Approaches in Laparoscopic Nephroureterectomies for Upper Tract Urothelial Carcinoma

“…Zhu et al conducted a review of tLNUs and rLNUs [ 15 ]. The results showed that the tLNU group had a significantly shorter operative time, a significantly longer recovery time of intestinal function, and no significant differences in the estimated blood loss, length of stay, visual analog pain scale, or overall complication rates.…”

Totally retroperitoneal approach for robot‐assisted nephroureterectomy with bladder cuff without repositioning

“…Radical nephroureterectomy using the retroperitoneal approach has various advantages such as direct access to the renal hilum, avoidance of the need for bowel mobilization, prevention of bowel complications, and faster postoperative recovery 1 . For this reason, the retroperitoneal approach has been widely used in laparoscopic surgery; however, BCE has often been performed by open surgery.…”

“…Radical nephroureterectomy with bladder cuff excision (BCE) is the gold standard treatment for high‐grade upper tract urothelial carcinomas. Compared with the transperitoneal approach, the retroperitoneal approach has the advantages of not requiring mobilization of the bowel and intraperitoneal organs and faster postoperative recovery of intestinal function 1 …”