Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases

Umberto Capitanio, Shahrokh F. Shariat, Hendrik Isbarn, Alon Weizer, Mesut Remzi, Marco Roscigno, Eiji Kikuchi, Jay D. Raman, Christian Bolenz, Karim Bensalah, Theresa M. Koppie, Wassim Kassouf, Mario I. Fernández, Philipp Ströbel, Jeffrey Wheat, Richard Zigeuner, Cord Langner, Matthias Waldert, Mototsugu Oya, Charles C. GuoCasey Ng, Francesco Montorsi, Christopher G. Wood, Vitaly Margulis, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

129 Scopus citations

Abstract

Background: Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce. Objective: We compared recurrence and cause-specific mortality rates of ONU and LNU. Design, setting, and participants: Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Measurements: Univariable and multivariable survival models tested the effect of procedure type (ONU [n = 979] vs LNU [n = 270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment. Results and limitations: Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p < 0.001) and less lymphovascular invasion (14.8% vs 21.3%, p = 0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p = 0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p < 0.001] and 2.0 [p = 0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p = 0.1 for both). Conclusions: Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalEuropean Urology
Volume56
Issue number1
DOIs
StatePublished - Jul 1 2009

    Fingerprint

Keywords

  • Laparoscopy
  • Nephroureterectomy
  • Recurrence
  • Survival
  • Upper tract urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Capitanio, U., Shariat, S. F., Isbarn, H., Weizer, A., Remzi, M., Roscigno, M., Kikuchi, E., Raman, J. D., Bolenz, C., Bensalah, K., Koppie, T. M., Kassouf, W., Fernández, M. I., Ströbel, P., Wheat, J., Zigeuner, R., Langner, C., Waldert, M., Oya, M., ... Karakiewicz, P. I. (2009). Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases. European Urology, 56(1), 1-9. https://doi.org/10.1016/j.eururo.2009.03.072