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Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2550–2562 | Cite as

Robotic-Assisted Surgery for Upper Tract Urothelial Carcinoma: A Comparative Survival Analysis

  • Matthew B. Clements
  • Tracey L. Krupski
  • Stephen H. Culp
Urologic Oncology

Abstract

Background

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.

Results

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.

Conclusions

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.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Matthew B. Clements
    • 1
  • Tracey L. Krupski
    • 1
  • Stephen H. Culp
    • 1
  1. 1.Department of UrologyUniversity of VirginiaCharlottesvilleUSA

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