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Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach. J Endourol 2017 Jul;31(7):661-665

Date

05/26/2017

Pubmed ID

28537436

DOI

10.1089/end.2017.0086

Scopus ID

2-s2.0-85024871706 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

OBJECTIVES: To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data.

METHODS: Using the National Cancer Database, we identified patients who underwent nephroureterectomy for localized upper tract urothelial carcinoma between 2010 and 2013. Demographic and clinicopathologic characteristics were compared among the three operative approaches. Multivariate regression analyses were used to determine the impact of approach on performance of lymphadenectomy (LND), positive surgical margins (PSM), and overall survival (OS).

RESULTS: In total, there were 9401 cases identified for analysis, including 3199 ONU (34%), 2098 RNU (22%), and 4104 LNU (44%). From 2010 to 2013, utilization of RNU increased from 14% to 30%. On multivariate analysis, LND was more likely in RNU (odds ratio [OR] 1.52; p < 0.01) and less likely in LNU (OR 0.77; p < 0.01) compared with ONU. RNU was associated with decreased PSM compared with ONU (OR = 0.73; p = 0.04). After adjusting for other factors, OS was not significantly associated with surgical approach.

CONCLUSIONS: RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

Author List

Rodriguez JF, Packiam VT, Boysen WR, Johnson SC, Smith ZL, Smith ND, Shalhav AL, Steinberg GD

Author

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Carcinoma, Transitional Cell
Female
Humans
Laparoscopy
Lymph Node Excision
Male
Margins of Excision
Middle Aged
Multivariate Analysis
Nephroureterectomy
Odds Ratio
Robotic Surgical Procedures
Survival Analysis
Ureter
Urologic Neoplasms