Comparison of Perioperative and Oncological Outcomes of Robot-assisted versus Pure Laparoscopic Nephroureterectomy in The Treatment of Upper Urinary Tract Urothelial Carcinoma
黃裕賓1、黃逸修1,2、鍾孝仁1,2、戴盟哲1、黃子豪1,2、魏子鈞1,2、范玉華1,2、林志杰1,2、
林子平1,2、郭俊逸1,2、盧星華1,2、張延驊1,2、林登龍1,2、黃志賢1,2
臺北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
機械手臂輔助與傳統腹腔鏡腎臟輸尿管併膀胱袖口切除手術治療上泌尿道上皮癌的手術與預後比較
Yu-Pin Huang1, Eric Y.H. Huang1,2, Hsiao-Jen Chung1,2, Meng-Che Tai1, Tzu-Hao Huang1,2,
Tzu-Chun Wei1,2, Yu-Hua Fan1,2, Chi-Cheh Lin1,2, Tzu-Ping Lin1,2, Junne-Yih Kuo1,2,
Shing-Hwa Lu1,2,Yen-Hwa Chang1,2, Alex T.L. Lin1,2,William J.S. Huang1,2
Department of Urology, Taipei Veterans General Hospital1
Department of Urology, School of Medicine and Shu-Tien Urological Research Institute,
National Yang-Ming University2, Taipei, Taiwan
Purpose:
Laparoscopic nephroureterectomy (LNU) has been introduced to the treatment of upper urinary tract urothelial carcinoma (UTUC) for decades and has become the standard of care. Robotic approach (RNU) was applied to such clinical scenario recently. Previous studies revealed comparable outcomes between laparoscopic and robotic approach, but only small numbers of patient cohort were reported. We presented our single institute experiences of RNU versus pure LNU in the treatment of UTUC.
Materials and Methods:
A retrospective review was performed for patients who underwent LNU or RNU for UTUC from March 2012 to October 2017 in our institute. The perioperative and oncological outcomes were compared between LNU and RNU.
Results:
A total of 231 patients were enrolled, including 87 RNU and 144 LNU, respectively. There were no significant differences between the two groups with respect to BMI (p=0.702), tumor location (p=0.272), and tumor stage (p=0.554). The mean duration of follow-up was 24.8 months for RNU and 31 months for LNU. No significant differences were noted regarding the total operative time (median 315 vs 320 minutes, p = 0.944), catheter time (median 5 vs 6 days, p = 0.586), and positive surgical margin rate (4.6% vs 8.3%, p = 0.404), operative complications (6.9% vs 6.9%, p=0.927) and post-operative complications (13.8% vs 14.6%, p=0.072). There were significantly higher estimated blood loss (EBL) and longer hospital stay for LNU (median EBL 150 vs 30 mL, p < 0.001; median hospital stay 9 vs 8 days, p=0.009).
The bladder recurrence rate (25.7% vs 26.4%, p=0.704) and distant metastatic rate (5.6% vs 8%, p=0.457) between LNU and RNU were not significantly different. No significant difference was observed between LNU and RNU in cancer-specific survival (p=0.923) and overall survival (p=0.534) by Kaplan-Meier analysis.
Conclusions:
In our experiences, LNU and RNU had similar perioperative and oncological outcomes. Nevertheless, RNU was superior to LNU in terms of lower EBL and shorter hospital stay.