Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions

Groote, Ruben De; Decaestecker, Karel; Larcher, Alessandro; Buelens, Sarah; Bleser, Elise De; D’Hondt, Frederiek; Schatteman, Peter; Lumen, Nicolaas; Montorsi, Francesco; Mottrie, A.; Naeyer, Geert De

doi:10.1007/s11701-019-00965-8

Cited by 30 publications

(15 citation statements)

References 29 publications

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“…Robotic approach yielded satisfactory oncological outcomes, even for advanced disease, with studies reporting a 5-year recurrence free survival of 57.1% in a series including 28.3% patients with pT3 and 6.7% pT4 disease (17). In the same pace, one of the biggest studies so far enrolling patients from three high volume robotic surgery centers, reported a low high grade complication rate (2.6%) with excellent intra-and post-operative results, suggesting this approach as a viable alternative to the gold standard open approach (18). The technology advancements of the robotic platform with the development of the DaVinci Xi system provided the surgeon' s more tools towards increasing experience in this approach, while decreasing operation room time (19).…”

Section: Discussionmentioning

confidence: 92%

Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis

Mourmouris

Argun

Tzelves

et al. 2021

Arch Ital Urol Androl

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Purpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m2 and in group 2 25.20 kg/m2. Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 3.3 days p = 0.006). Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.

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Section: Discussionmentioning

confidence: 92%

Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis

Mourmouris

Argun

Tzelves

et al. 2021

Arch Ital Urol Androl

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“…It presented similar results in cancer control and progression-free survival. However, as documented in this study, no comparisons were made between the different techniques (1).…”

Section: João Paulo Martins De Carvalho MDmentioning

confidence: 88%

Editorial Comment: Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

Carvalho¹

2020

Int. braz j urol.

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This is a meta-analysis of the latest publications on robotic nephro ureterectomy (RNU) comparing it with other techniques. Through research of publications over the last 20 years until April 2019. The authors were able to filter 80 studies as eligible for research. They performed a historical review that adopted nephro ureterectomy with bladder cuff removal as the gold standard for curable resectability in high-grade upper urinary tract urothelial carcinoma. Over the years, open techniques have been replaced by laparoscopic and laparoscopic robotic assisted. However, robust data are lacking comparing the different techniques regarding intra and postoperative results. Thus, these variables were evaluated in the most different studies: age, gender, body mass index (BMI), race (Caucasian), Charlson Comorbidity Index (CCI)≥2, American Society of Anesthesiologist (ASA) score≥3, tumor location (pelvicalyceal, ureteral, multifocal), and surgery performed in an academic hospital;-surgical outcomes: estimated blood loss (EBL), operative time (OT), intraoperative complications, transfusions, overall complications, major complications (Clavien≥3), and length of stay;-pathological outcomes: pT≥3, high-grade tumor, pN+, nodes removed, and positive surgical margins (PSM);-survival outcomes: recurrence, metastasis, death, 2-and 5-years recurrence free survival (RFS), 2-and 5-years cancer specifc survival (CSS), and correlation between surgical technique and RFS and CSS.

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“…In addition, the major Clavien-Dindo complications were highest in HALNU and lowest in RNU. Three-dimensional vision, greater flexibility, instrument accuracy, and better ergonomics of RNU may translate into lower complications ( 25 , 26 ). A meta-analysis of NU techniques has demonstrated that RNU has a low incidence of intraoperative complications ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

Chang

Huang

et al. 2021

Front. Oncol.

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PurposeThis study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy.MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches.ResultsAmong the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001).ConclusionsMinimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.

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Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions

Cited by 30 publications

References 29 publications

Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis

Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis

Editorial Comment: Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma

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