Comparison of oncological outcomes for hand-assisted and pure laparoscopic radical nephroureterectomy: results from the Taiwan Upper Tract Urothelial Cancer Collaboration Group

Chih Chin Yu, Chung Hsin Chen, Jian Hua Hong, Hung Lung Ke, Wei Ming Li, Shiu Dong Chung, Wei Che Wu, Yung Tai Chen, Yuan Hong Jiang, Yu Hua Lin, Wei Yu Lin, Chia Chang Wu, Yao Chou Tsai

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Laparoscopic radical nephroureterectomy (LNU) has gradually become the new standard treatment for localized upper tract urothelial cancer (UTUC). With more blunt dissection and tactile sensation, hand-assisted LNU might shorten the operative time compared with the pure laparoscopic approach. However, whether the use of the hand-assisted or the pure laparoscopic approach has an effect on oncological outcomes remains unclear. Methods: We retrospectively identified 629 patients with non-metastatic UTUC who underwent hand-assisted (n = 515) or pure LNU (n = 114) at 9 hospitals in Taiwan between 2004 and 2019. Overall survival, cancer-specific survival, recurrence-free survival, and bladder recurrence-free survival were compared between these two groups using inverse-probability of treatment weighting (IPTW) derived from the propensity scores for baseline covariate adjustment. Results: The median follow-up period was 32.9 and 28.7 months in the hand-assisted and the pure groups, respectively. IPTW-adjusted Cox proportional hazards models showed that the laparoscopic approach (pure vs. hand-assisted) was not significantly associated with all-cause mortality (HR 0.79, 95% CI 0.49–1.24, p = 0.304), cancer-specific mortality (HR 0.88, 95% CI 0.51–1.51, p = 0.634), or extra-vesical recurrence (HR 0.65, 95% CI 0.41–1.04, p = 0.071). However, the pure laparoscopic approach was significantly associated with lower intra-vescial recurrence (HR 0.64, 95% CI 0.43–0.96, p = 0.029) for patients who underwent LNU. Kaplan-Meier curves also revealed that the pure laparoscopic approach was associated with better bladder recurrence-free survival compared with the hand-assisted laparoscopic approach in both the original cohort and the IPTW-adjusted cohort (log-rank p = 0.042 and 0.027, respectively). Conclusions: The performance of hand-assisted or pure LNU does not significantly affect the all-cause mortality, cancer-specific mortality, or extra-vesical recurrence for patients with non-metastatic UTUC. However, the hand-assisted laparoscopic approach could increase the risk of intra-vesical recurrence for patients who undergo LNU.

Original languageEnglish
JournalSurgical endoscopy
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Hand-assisted
  • Laparoscopic nephroureterectomy
  • Oncological outcomes
  • Upper tract urothelial cancer

ASJC Scopus subject areas

  • Surgery

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