Robot-assisted versus open radical nephroureterectomy for urothelial carcinoma of the upper urinary tract: A retrospective cohort study across ten years

Zeuschner, Philip; Vollmer, S. Grosse; Linxweiler, Johannes; Wagenpfeil, Gudrun; Wagenpfeil, Stefan; Saar, Matthias; Siemer, Stefan; Stöckle, Michael; Heinzelbecker, Julia

doi:10.1016/j.suronc.2021.101607

Cited by 17 publications

(16 citation statements)

References 35 publications

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“…3,5,14 Our results can be compared with prior historical series of high-risk UTUC treated with RNU and without NAC, in which 2-and 5-year OS rates have ranged from 68% to 84% and 29% to 62%, respectively. 15,[24][25][26] Several other historical series have also reported recurrence-free survival or relapse-free survival with definitions equivalent to our PFS outcome (ie, metastasis, local nonurothelial recurrence, or death). These 2-and 5year survival outcomes have ranged from 50% to 76% and 40% to 68%, respectively.…”

Section: Discussionsupporting

confidence: 67%

Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma

Coleman

Yip

Wong

et al. 2023

JCO

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PURPOSE Neoadjuvant chemotherapy (NAC) has proven survival benefits for patients with invasive urothelial carcinoma of the bladder, yet its role for upper tract urothelial carcinoma (UTUC) remains undefined. We conducted a multicenter, single-arm, phase II trial of NAC with gemcitabine and split-dose cisplatin (GC) for patients with high-risk UTUC before extirpative surgery to evaluate response, survival, and tolerability. METHODS Eligible patients with defined criteria for high-risk localized UTUC received four cycles of split-dose GC before surgical resection and lymph node dissection. The primary study end point was rate of pathologic response (defined as < ypT2N0). Secondary end points included progression-free survival (PFS), overall survival (OS), and safety and tolerability. RESULTS Among 57 patients evaluated, 36 (63%) demonstrated pathologic response (95% CI, 49 to 76). A complete pathologic response (ypT0N0) was noted in 11 patients (19%). Fifty-one patients (89%) tolerated at least three complete cycles of split-dose GC, 27 patients (47%) tolerated four complete cycles, and all patients proceeded to surgery. With a median follow up of 3.1 years, 2- and 5-year PFS rates were 89% (95% CI, 81 to 98) and 72% (95% CI, 59 to 87), while 2- and 5-year OS rates were 93% (95% CI, 86 to 100) and 79% (95% CI, 67 to 94), respectively. Pathologic complete and partial responses were associated with improved PFS and OS compared with nonresponders (≥ ypT2N any; 2-year PFS 100% and 95% v 76%, P < .001; 2-year OS 100% and 100% v 80%, P < .001). CONCLUSION NAC with split-dose GC for high-risk UTUC is a well-tolerated, effective therapy demonstrating evidence of pathologic response that is associated with favorable survival outcomes. Given that these survival outcomes are superior to historical series, these data support the use of NAC as a standard of care for high-risk UTUC, and split-dose GC is a viable option for NAC.

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Section: Discussionsupporting

confidence: 67%

Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma

Coleman

Yip

Wong

et al. 2023

JCO

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“…In more recent years, the discussion has de facto shifted towards the “oncological safety” of robotic RNU, which seems to offer less surgical morbidity when compared to open RNU ( 4 ). A small number of retrospective studies have shown robotic RNUs to produce comparable oncologic outcomes to laparoscopic and open RNUs ( 36 - 40 ) ( Table 3 ). In a large meta-analysis involving over 80,000 patients, no correlation was found between surgical technique—including open, laparoscopic, and robotic—and recurrence-free and cancer-specific survival outcomes ( 4 ).…”

Section: The Impact Of Surgical Techniquementioning

confidence: 99%

Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review

Grob,

Rogers,

Pandolfo

et al. 2023

Transl Androl Urol

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Background and Objective Radical nephroureterectomy (RNU) represents the gold standard treatment for non-metastatic upper tract urothelial cancer. We sought to provide a comprehensive review of reported oncologic outcomes of the RNU procedure and of factors that might impact these outcomes. Methods A non-systematic review of the literature was conducted by performing an electronic literature search using PubMed with “radical nephroureterectomy” and “oncologic outcomes” as free text search terms. Both original articles and systematic reviews were considered. Search was limited to articles in English that were published in the last 20 years. Key Content and Findings Open and laparoscopic RNU offer comparable oncologic outcomes. In more recent years, the discussion has de facto shifted towards the “oncological safety” of robotic RNU, which also seems to offer comparable oncologic outcomes. Several studies have looked at the impact of different treatment-, patient- and tumor-related factors. Among treatment-related factors, attention has been given to diagnostic ureteroscopy and the risk of intravesical recurrence. Surgical wait time and perioperative blood transfusion have also been studied. Perioperative chemotherapy, specifically adjuvant therapy, was shown to improve survival. Among patient-related factors, baseline chronic kidney disease, diabetes mellitus, body mass index, and systemic inflammation have gained recent attention. Some tumor related factors, such as stage, grade, location, and multifocality may negatively impact survival outcomes. Lymphovascular invasion and histologic variants are clinically significant pathological findings. Conclusions RNU is a procedure with measured long-term oncologic outcomes. Minimally invasive techniques have gained an established role as they seem to offer comparable oncologic “safety”, although special attention is needed in relation to the method of bladder cuff excision. Robotic RNU is gaining popularity, and while evidence remains limited, the current literature supports the oncologic safety of this procedure. Several factors, which can be categorized as treatment-related, patient-related, and tumor-related, might impact the oncologic outcomes of UTUC patients undergoing RNU. These factors can provide crucial information to stratify patients based on their relative risk of disease recurrence and mortality which may guide clinical decision-making.

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“…Although there are no absolute contraindications to the use of open technique for managing UTUC, it may be relatively difficult in obese patients and patients with history of pelvic surgery or irradiation. Furthermore, while the open approach yields comparable oncological outcomes to minimally invasive approaches, it is associated with poorer peri-operative outcomes ( 24 , 34 , 35 ).…”

Section: Open Radical-nephroureterectomymentioning

confidence: 99%

“…The 2-year OS was 76.2% in RAL-NU vs. 68.4% in open, which was also not statistically significant. Regression analysis revealed that the surgical approach did not impact the PFS or OS ( 35 ).…”

Section: Current Evidencementioning

confidence: 99%

Robotic nephroureterectomy supplanting open and laparoscopic approach for upper tract urothelial carcinoma management: a narrative review

Zuluaga,

Rich,

Razdan

et al. 2023

Transl Androl Urol

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Background and Objective The use of robotic surgery for managing upper tract urothelial carcinoma (UTUC) has increased significantly over the years. Minimally invasive techniques (MIS) are now used for approximately half of all robot-assisted laparoscopic nephroureterectomy (RAL-NU) performed in the USA. However, there are currently no specific management guidelines that recommend the use of a robotic approach, and the available literature on this topic is limited. For this reason, we reviewed the history and current literature regarding this technique. Methods We searched Web of Science and PubMed for articles between 1934 to 2023 using 20 different search terms and combinations. We restricted our selection to only publications in English language. Key Content and Findings Comparative retrospective studies between techniques [open nephroureterectomy (ONU), laparoscopic nephroureterectomy (LNU), and RAL-NU] and case series of surgical groups, mostly at short- and mid-term follow-up, were included. Conclusions Robotic surgery for UTUC is on the rise and is predicted to become the preferred method for nephroureterectomy. A comparison of RAL-NU to LNU and ONU shows several advantages, including less blood loss, pain, and hospital stay, as well as a quicker recovery time. The safety and effectiveness of robotic surgery for lymphadenectomy also supports its use in RAL-NU. As more medical facilities adopt the technique and further studies support its benefits, it is likely that robotic surgery will become the preferred method for NU.

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Robot-assisted versus open radical nephroureterectomy for urothelial carcinoma of the upper urinary tract: A retrospective cohort study across ten years

Cited by 17 publications

References 35 publications

Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma

Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma

Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review

Robotic nephroureterectomy supplanting open and laparoscopic approach for upper tract urothelial carcinoma management: a narrative review

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