1天主教耕莘醫院 外科部泌尿科、2中國醫藥大學附設醫院泌尿部、3中國醫藥大學新竹附設醫院泌尿科、4中國醫藥大學醫學系、5國立台灣大學附設醫院 泌尿部、6國立台灣大學醫學院、7高雄醫學大學附設中和紀念醫院泌尿部、8高雄醫學大學醫學系泌尿學科、9高雄醫學大學臨床醫學研究所、10佛教慈濟醫療財團法人台北慈濟醫院外科部泌尿科、11花蓮慈濟大學醫學院、12基督復臨安息日會醫療財團法人臺安醫院泌尿科、13醫療財團法人徐元智先生醫藥基金會亞東紀念醫院外科部泌尿科、14元智大學生物與醫學資訊研究所、15台北市立聯合醫院外科部泌尿科、16國立陽明交通大學醫學系泌尿學科、17國立陽明交通大學醫學院、18台北醫學大學醫學院醫學系泌尿學科、19台北醫學大學附設醫院泌尿科、20台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院泌尿科、21馬偕學校財團法人馬偕醫學院、22國立陽明交通大學生物醫學資訊研究所、23高雄榮民總醫院泌尿外科、24佛教慈濟醫療財團法人花蓮慈濟醫院泌尿部、25衛生福利部雙和醫院泌尿科、26台北醫學大學醫學院醫學系泌尿科、27臺北醫學大學泌尿腎臟研究中心、28長庚醫療財團法人嘉義長庚紀念醫院泌尿科、29嘉義長庚學校財團法人長庚科技大學、30長庚大學醫學系、 31天主教輔仁大學附設醫院泌尿科、32天主教輔仁大學醫學院、33國立台灣師範大學生命科學院
Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy from Taiwan upper urinary tract urothelial carcinoma database
Chih-Chun Kuo1,5, Guang-Heng Chen2,3, Chao-Hsiang Chang2,4, Chao-Yuan Huang5,6, Chung-Hsin Chen5,6, Ching-Chia Li7,8,9, Wen-Jeng Wu7,8,9, Chih-Chin Yu10,11, Chi-Wen Lo10, Yung-Tai Chen12, Shin-Hong Chen12, Shiu-Dong Chung13,14, Pai-Yu Cheng13, Thomas Y. Hsueh15,16, Allen W. Chiu17, Yao-Chou Tsai18,19, Fang-Yu, Ku18, Jen-Shu Tseng20,21,22, Jen-Tai Lin23, Yuan-Hong Jiang24, Chia-Chang Wu25,26,27, Wei-Yu Lin28,29,30, Hsu-Che Huang1,31, Han-Sun Chiang1,31, and Bing-Juin Chiang1,32,33
1Department of Urology, Cardinal Tien Hospital. 2Department of Urology, China Medical University and Hospital. 3Department of Urology, China Medical University Hsinchu Hospital. 4School of Medicine, China Medical University. 5Department of Urology, National Taiwan University Hospital. 6College of Medicine, National Taiwan University. 7Department of Urology, Kaohsiung Medical University Hospital. 8Department of Urology, School of Medicine, Kaohsiung Medical University. 9Graduate Institute of Clinical Medicine, Kaohsiung Medical University. 10Division of Urology, Department of surgery, Taipei Tzu Chi Hospital. 11School of Medicine, Buddhist Tzu Chi University. 12Department of Urology, Taiwan Adventist Hospital. 13Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital. 14Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University. 15Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch. 16Department of Urology, School of Medicine, National Yang Ming Chiao Tung University. 17College of Medicine, National Yang Ming Chiao Tung University. 18Department of Urology, School of Medicine, College of Medicine, Taipei Medical University. 19Department of Urology, Taipei Medical University Hospital, Taipei Medical University. 20Department of Urology, MacKay Memorial Hospital. 21Mackay Medical College. 22Institute of Biomedical Informatics, National Yang Ming Chiao Tung University. 23Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital. 24Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University. 25Department of Urology, Shuang Ho Hospital, Taipei Medical University. 26Department of Urology, School of Medicine, College of Medicine, Taipei Medical University. 27TMU Research Center of Urology and Kidney, Taipei Medical University. 28Division of Urology, Department of Surgery, Chang Gung Memorial Hospital. 29Chang Gung University of Science and Technology.
30Department of Medicine, Chang Gung University. 31Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University. 32School of Medicine, Fu-Jen Catholic University. 33Department of Life Science, College of Science, National Taiwan Normal University.
Taiwan has a high incidence of upper tract urothelial carcinoma (UTUC), but no single method of laparoscopic nephroureterectomy (LNU) has been proven for the best oncological outcome and most patients are concentrated at tertiary centers. Thus, we conducted a multi-institute retrospective study to evaluate the influence of surgical experience on oncological outcomes following transperitoneal pure laparoscopic NU (TP-LNU) and transperitoneal hand-assisted LNU (TP-HALNU) in the Taiwanese population.
Materials and Methods:
Our research group enrolled 14 hospitals in Taiwan and acquired a UTUC patient database from the Taiwan Cancer Registry. We retrospectively reviewed patient records between July 1988 and September 2020, of which 622 patients received LNU. A total of 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncologic outcomes were compared.
Of the 322 patients, 181 and 141 patients received TP-LNU and TP-HALNU, respectively. There were no differences in the clinical and histopathological data between the two groups. TP-HALNU showed a slightly higher overall mortality rate, but no differences were observed in perioperative and postoperative complications. The two approaches showed no differences in oncological outcomes. Age > 70 years, positive pathological lymph metastasis, and tumors located in the upper ureter were predictive factors associated with an increased risk of oncological outcomes. Female sex was the sole protective factor for oncological outcomes. Hospitals with surgical experience over 20 cases showed lower risk on overall survival.
Hospitals with surgical experience over 20 cases are qualified for patients with UTUC to receive laparoscopic nephroureterectomy. No significant difference in oncological outcomes was seen between TP-LNU and TP-HALNU; perioperative and postoperative complication rates were also comparable. Age, sex, lymph node metastasis, and tumor in the upper ureter were predictive factors for oncological outcomes.