Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis.

Published on Apr 21, 2021in World Journal of Surgical Oncology2.754
· DOI :10.1186/S12957-021-02236-Z
Radosław Piszczek3
Estimated H-index: 3
,
Łukasz Nowak3
Estimated H-index: 3
(Wrocław Medical University)
+ 5 AuthorsRomuald Zdrojowy14
Estimated H-index: 14
(Wrocław Medical University)
Source
Abstract
BACKGROUND During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU. MATERIALS AND METHODS The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled. RESULTS Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60-1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62-1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85-1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94-1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter. CONCLUSIONS Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.
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#1Marco Moschini (Medical University of Vienna)H-Index: 28
#2Stefania Zamboni (University of Brescia)H-Index: 9
Last. Philipp BaumeisterH-Index: 7
view all 28 authors...
To compare oncological outcomes of open (ORNU) and laparoscopic radical nephroureterectomy (LRNU) after controlling for preoperative patient-derived factors.We evaluated a multi-institutional colla...
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#1Keisuke Shigeta (Keio: Keio University)H-Index: 7
#2Kazuhiro Matsumoto (Keio: Keio University)H-Index: 22
Last. Mototsugu Oya (Keio: Keio University)H-Index: 56
view all 12 authors...
To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparosco...
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#1Avery E. BraunH-Index: 1
#2Abhishek Srivastava (Fox Chase Cancer Center)H-Index: 2
Last. Alexander KutikovH-Index: 53
view all 4 authors...
Upper tract urothelial carcinoma (UTUC) accounts for roughly 5% of urothelial carcinomas. Historically, the gold standard for high-risk or bulky low-risk UTUC was an open radical nephroureterectomy with formal bladder cuff excision (BCE). The development of novel endoscopic, laparoscopic, and robotic techniques has transformed this operation, yet no level I evidence exists at present that demonstrates the superiority of one strategy over another. While new approaches to nephroureterectomy in the...
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#1Vitaly Margulis (UTSW: University of Texas Southwestern Medical Center)H-Index: 66
#2Maneka Puligandla (Harvard University)H-Index: 13
Last. Jean H. Hoffman-Censits (Johns Hopkins University)H-Index: 21
view all 11 authors...
Purpose:Data supporting neoadjuvant chemotherapy (NAC) in high-grade (HG) upper-tract urothelial carcinoma (UTUC) is scant. This multi-institution prospective phase II trial investigated pathologic...
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#1Nessn H. Azawi (UCPH: University of Copenhagen)H-Index: 7
Last. Jørgen Bjerggaard Jensen (AU: Aarhus University)H-Index: 32
view all 8 authors...
AbstractObjective: To report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large study sample.Materials and methods: This was a nationwide...
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#1Jeffrey J. Leow (NTU: Nanyang Technological University)H-Index: 26
#2Zhenbang Liu (NTU: Nanyang Technological University)H-Index: 1
Last. Yew-Lam Chong (NTU: Nanyang Technological University)H-Index: 2
view all 6 authors...
Introduction: Upper tract urothelial carcinoma (UTUC) is a relatively uncommon urologic malignancy for which there has not been significant improvement in survival over the past few decades, highlighting the need for optimal multi-modality management. Methods: A non-systematic review of the latest literature was performed to include relevant articles up to June 2019. It summarizes the epidemiologic risk factors associated with UTUC, including smoking, carcinogenic aromatic amines, arsenic, arist...
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#1Keisuke Shigeta (Keio: Keio University)H-Index: 7
#2Eiji Kikuchi (Keio: Keio University)H-Index: 54
Last. Mototsugu Oya (Keio: Keio University)H-Index: 56
view all 12 authors...
Background This study aimed to investigate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) for patients with clinical and pathologic T3N0M0 upper tract urothelial carcinoma (UTUC).
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#1Sung-Han KimH-Index: 60
#2Mi Kyung SongH-Index: 4
Last. Ho Kyung SeoH-Index: 19
view all 8 authors...
PURPOSE: The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma. MATERIALS AND METHODS: The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Societ...
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#1Hakmin Lee (Seoul National University Bundang Hospital)H-Index: 8
#2Hak Ju Kim (Seoul National University Bundang Hospital)H-Index: 1
Last. Seok-Soo Byun (SNU: Seoul National University)H-Index: 33
view all 5 authors...
Background To compare the oncological and perioperative outcomes of different nephroureterectomy approaches in patients with non-metastatic upper tract urothelial carcinoma (UTUC). Methods We retrospectively analyzed the data of 422 patients who underwent open, laparoscopic, or robotic nephroureterectomy for non-metastatic UTUC. Perioperative and postoperative survival outcomes were compared using Kaplan-Meier analyses and Cox-proportional hazard models. Results Of the patients, 161, 137, and 12...
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#1Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 68
#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 29
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
view all 3 authors...
: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the Nati...
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Cited By3
Newest
#1Samuel Morriss (University of Melbourne)
#2Homayoun Zargar (University of Melbourne)H-Index: 12
Last. Brendan Hermenigildo Dias (University of Melbourne)
view all 3 authors...
Introduction: Radical open nephroureterectomy (ONU) with bladder cuff excision (BCE) is the traditional gold standard approach for management of high-risk non-metastatic upper tract urothelial cancer. ONU involves two separate procedures; the nephrectomy and distal ureterectomy, with each of these parts being able to be performed with an open or minimally-invasive approach. Multiple approaches have been described for the resection of the distal ureter and bladder cuff after mobilization of the k...
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#1Yuchen BaiH-Index: 1
view all 9 authors...
Background null With the development of minimally invasive surgery technology, patients with bladder cancer are increasingly receiving laparoscopic radical cystectomy (LRC) or robotic-assisted radical cystectomy (RARC) treatment. The main purpose of this study was to compare the long-term outcomes of bladder cancer patients treated with LRC versus RARC. null Methods null A retrospective study to identify patients with clinical stage Ta/T1/Tis to T3 bladder cancer who underwent RARC or LRC has be...
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#1Maximilian SelesH-Index: 10
#2J. MischingerH-Index: 2
Last. Richard ZigeunerH-Index: 72
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#1Hairong HeH-Index: 13
Last. Ye Gao
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#2Yang WangH-Index: 9
Last. Qing YangH-Index: 15
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