Oncologic Outcomes Following Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma

• Published in: The Journal of urology Vol. 194; no. 6; pp. 1561 - 1566
• Main Authors: Aboumohamed, Ahmed A, Krane, Louis Spencer, Hemal, Ashok K
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Aged; Aged, 80 and over; carcinoma; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy - methods; Male; Middle Aged; mortality; Neoplasm Invasiveness; Neoplasm Staging; nephrectomy; Nephrectomy - methods; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Robotic Surgical Procedures - methods; robotics; Ureter - surgery; Ureteral Neoplasms - mortality; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; urinary bladder; Urinary Bladder - surgery; Urology; carcinoma in situ; CSS; cancer specific survival; OS; glomerular filtration rate; urinary bladder; robotics; UTUC; upper tract urothelial carcinoma; RNUBCE; CIS; GFR; robotic nephroureterectomy with bladder cuff excision; lymphovascular invasion; carcinoma; metastasis-free survival; recurrence-free survival; mortality; overall survival; nephrectomy; MFS; LVI; RFS
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2015.07.081

Purpose Robot-assisted laparoscopic nephroureterectomy with bladder cuff excision is a minimally invasive alternative to open surgery for managing upper tract urothelial carcinoma. We report oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision. Materials and Methods The records of the initial 65 patients who underwent robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma between 2008 and 2014 were reviewed from our institutional review board approved, prospectively maintained database. All patients underwent surgery with the single docking technique. Baseline demographic features, pathological variables and perioperative data were analyzed. Kaplan-Meier methodology was used for survival analysis. Cox proportional hazards regression was applied to determine the prognostic effect of different variables on survival. Results Mean patient age was 69.1 years. Final pathological evaluation revealed pT2 stage or lower in 65% of patients, pT3 in 28.3% and pT4 in 6.7%. High grade pathological findings were present in 85% of patients, including 13.3% with concomitant carcinoma in situ and 30% with lymphovascular invasion. Median followup was 25.1 months (range 6 to 68.9). At 2 and 5 years overall survival was 86.9% and 62.6%, cancer specific survival was 92.9% and 69.5%, and recurrence-free survival was 65.3% and 57.1%, respectively. A total of 23 patients experienced disease recurrence. Bladder recurrence developed in 15 patients, 12 had isolated bladder recurrence and 8 had metastatic disease. On univariate analysis age greater than 70 years, preoperative hydronephrosis, nodal disease and concomitant carcinoma in situ were significantly associated with decreased recurrence-free survival (p = 0.002, 0.04, 0.006 and 0.001, respectively). However, none was statistically significant on multivariate analysis. On univariate analysis impaired preoperative renal function (creatinine greater than 2 mg/dl) and lymphovascular invasion were associated with reduced cancer specific survival (p = 0.03 and 0.01, respectively). However, only lymphovascular invasion was associated with decreased cancer specific survival on multivariate analysis (p = 0.048). Conclusions Our reported data on oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma demonstrate satisfactory oncologic control at intermediate term followup. Long-term outcomes are required to assess true efficacy.