Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Abstract

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large populationbased cohort of patients with upper-tract urothelial carcinoma (UTUC). Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU. IntroductionUpper-tract urothelial carcinoma (UTUC) accounts for about 5% of all urothelial carcinomas.1 According to treatment guidelines, radical nephroureterectomy (RNU) represents the treatment of choice for localized disease.2 Based on equal efficacy and easier convalescence compared to the open procedure, many urologists have advocated minimally invasive approaches as the standard of care. 2,3 In this context, laparoscopic nephroureterectomy (LNU) and robotic-assisted nephroureterectomy (RANU) are available; the robotic approach is being increasingly adopted for several other urologic malignancies.4 That being said, there is little data evaluating the safety and feasibility of RANU.5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs. (NIS) database were abstracted. The NIS is a 20% stratified probability sample that encompasses about 8 million ...

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

“…Furthermore, our analyses also allowed us to examine differences in LNU and RANU over time. To the best of our knowledge, we are the second, after Trudeau et al ., to show a decreased rate of LNU with a concomitant increase in RANU. This trend corroborates greater use of robotics, with the virtual disappearance of laparoscopic urological surgeries.…”

“…Several population‐based and institutional series tested intraoperative and postoperative complications rates, as well as LOS. They predominantly addressed differences between LNU and ONU, RANU and LNU and RANU and ONU . However, only one contemporary population‐based study compared MINU with ONU .…”

“…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 . Despite the growing interest in minimally invasive surgery, only one formal comparison of intraoperative and postoperative outcomes has been reported for MINU versus ONU.…”

“…5 In more recent years, RANU also had promising perioperative and oncological outcomes. 6,7 Despite the growing interest in minimally invasive surgery, only one formal comparison of intraoperative and postoperative outcomes has been reported for MINU versus ONU. To address this limitation, we carried out similar analyses in a larger and more contemporary patient cohort.…”

Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

“…[1][2][3][4][5] Approximately 20-40% of patients initially present with locally advanced disease and lymph node (LN) metastases at the time of diagnosis. [6][7][8][9] Recently, Margulis et al identified age, high tumour grade, high pathological T stage, LN metastasis, sessile architecture, an infiltrative growth pattern, and lymphovascular invasion (LVI) as independent prognostic indicators of disease recurrence and cancer-specific survival (CSS).…”