Robotic-Assisted Surgery for Upper Tract Urothelial Carcinoma: A Comparative Survival Analysis
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We performed a comparative survival analysis of patients undergoing robotic-assisted versus laparoscopic or open surgery for upper tract urothelial carcinoma (UTUC).
Materials and Methods
Patients diagnosed with non-metastatic UTUC undergoing removal of the kidney and/or ureter were identified using Medicare-linked Surveillance, Epidemiology, and End Results Program data (2004–2013). Patients aged 65–85 years were categorized based on surgical approach (open, laparoscopic, or robotic-assisted). Kaplan–Meier methods were used to determine survival (overall and cancer-specific) and intravesical recurrence rates, the former using a propensity score-weighted model. Independent predictors of survival were determined using multivariable Cox proportional hazards regression analysis.
We identified a total of 3801 patients meeting the final inclusion criteria: open (n = 1862), laparoscopic (n = 1624), and robotic (n = 315). Robotic surgery was associated with the shortest length of hospital stay (p < 0.001) but highest in-hospital charges (p < 0.001), with no difference in readmission rates (p = 0.964). No difference was found in overall or cancer-specific survival in the robotic cohort when compared with open or laparoscopic surgery. In addition, no difference in the rate of intravesical recurrence was noted in robotic-assisted laparoscopy compared with the other groups. The sole predictor of improved survival was extent of lymphadenectomy, which was highest in the robotic cohort.
Using a large, population-based cancer database, there was no survival difference when a robotic-assisted approach was utilized in patients undergoing surgery for UTUC. These findings are important with the increased use of robotic surgery in the management of UTUC.
- 4.Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, et al. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study. BJU Int. 2012;110:1134–41.CrossRefPubMedGoogle Scholar
- 12.Ariane MM, Colin P, Ouzzane A, Pignot G, Audouin M, Cornu J-N, et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol. 2012;19:301–8.CrossRefPubMedGoogle Scholar
- 14.National Cancer Institute. Calculation of Comorbidity Weights—SEER-Medicare n.d. https://healthcaredelivery.cancer.gov/seermedicare/program/comorbidity.html. Accessed 29 Jan 2017.
- 15.Brien TO, Ray E, Singh R, Coker B, Beard R, Centre U, et al. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C trial). Eur Urol. 2011;60:703–10.CrossRefGoogle Scholar
- 19.Chappidi MR, Kates M, Johnson MH, Hahn NM, Bivalacqua TJ, Pierorazio PM. Lymph node yield and tumor location in patients with upper tract urothelial carcinoma undergoing nephroureterectomy affects survival: A U.S. population based analysis (2004 to 2012). Urol Oncol Semin Orig Investig. 2016;34:531.e15–531.e24.Google Scholar
- 25.Favaretto RL, Shariat SF, Chade DC, Godoy G, Kaag M, Cronin AM, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: Are recurrence and disease-specific survival associated with surgical technique? Eur Urol. 2010;58:645–51.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.National Cancer Institute. Overview of the SEER Program. https://seer.cancer.gov/about/overview.html. Accessed 30 Jan 2017.