Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: Are recurrence and disease-specific survival associated with surgical technique? Journal Article

   

Authors:	Favaretto, R. L.; Shariat, S. F.; Chade, D. C.; Godoy, G.; Kaag, M.; Cronin, A. M.; Bochner, B. H.; Coleman, J.; Dalbagni, G.
Article Title:	Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: Are recurrence and disease-specific survival associated with surgical technique?
Abstract:	Background: Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective: Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants: We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n = 109) or LRN (n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention: All patients underwent RN. Measurements: Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations: Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p = 0.4) or disease-specific mortality (p = 0.9). This study is limited by its retrospective nature. Conclusions: Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN. © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords:	survival; adult; cancer survival; aged; surgical technique; major clinical study; mortality; cancer recurrence; comparative study; disease free survival; follow up; laparoscopy; laparoscopic surgery; disease association; incidence; cohort analysis; recurrence; surgical approach; retrospective study; bladder cancer; distant metastasis; cancer invasion; confidence interval; proportional hazards model; death; probability; urothelial carcinoma; nephroureterectomy; multivariate analysis; hazard ratio; kaplan meier method; univariate analysis; transitional cell carcinoma; log rank test
Journal Title:	European Urology
Volume:	58
Issue:	5
ISSN:	0302-2838
Publisher:	Elsevier Science, Inc.
Date Published:	2010-11-01
Start Page:	645
End Page:	651
Language:	English
DOI:	10.1016/j.eururo.2010.08.005
PROVIDER:	scopus
PUBMED:	20724065
PMCID:	PMC4167427
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-77957587419&partnerID=40&md5=cd4dfee76815450c6708f58b3599812e
Notes:	--- - "Cited By (since 1996): 4" - "Export Date: 20 April 2011" - "CODEN: EUURA" - "Source: Scopus"

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