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World Journal of Urology

, Volume 37, Issue 11, pp 2303–2311 | Cite as

Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience

  • Riccardo Campi
  • Juliette Cotte
  • Francesco Sessa
  • Thomas Seisen
  • Riccardo Tellini
  • Daniele Amparore
  • Nicola Mormile
  • Aurélien Gobert
  • Andrea Mari
  • Francesco Porpiglia
  • Sergio Serni
  • Andrea Minervini
  • Morgan RouprêtEmail author
Topic Paper

Abstract

Purpose

To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC).

Methods

Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU.

Results

81 patients were included. No case required conversion to open surgery. Early major (Clavien–Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was − 1 ml/min/1.73 m2 after SU and − 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease.

Conclusion

Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.

Keywords

Radical nephroureterectomy Renal pelvis Robotics Segmental ureterectomy Ureter Urothelial carcinoma 

Notes

Author contribution

RC: project concept and design, drafting of the manuscript. JC: data collection, drafting of the manuscript. FS: data collection, critical revision of the manuscript. TS: critical revision of the manuscript. RT: data collection, data analysis. DA: data collection. NM: data collection. AG: data collection. AM: critical revision of the manuscript. FP: critical revision of the manuscript. SS: critical revision of the manuscript. AM: critical revision of the manuscript. MR: project concept and design, critical revision of the manuscript, supervision

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Riccardo Campi
    • 1
    • 2
  • Juliette Cotte
    • 3
  • Francesco Sessa
    • 1
  • Thomas Seisen
    • 3
  • Riccardo Tellini
    • 1
  • Daniele Amparore
    • 4
  • Nicola Mormile
    • 1
  • Aurélien Gobert
    • 3
  • Andrea Mari
    • 1
    • 2
  • Francesco Porpiglia
    • 4
  • Sergio Serni
    • 1
    • 2
  • Andrea Minervini
    • 1
    • 2
  • Morgan Rouprêt
    • 3
    Email author
  1. 1.Department of Urology, Careggi HospitalUniversity of FlorenceFlorenceItaly
  2. 2.Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  3. 3.Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
  4. 4.Department of UrologySan Luigi Gonzaga HospitalTurinItaly

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