Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: Are recurrence and disease-specific survival associated with surgical technique?

Ricardo L. Favaretto, Shahrokh F. Shariat, Daher C. Chade, Guilherme Godoy, Matthew G. Kaag, Angel M. Cronin, Bernard H. Bochner, Jonathan Coleman, Guido Dalbagni

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Abstract

Background: Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective: Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants: We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n = 109) or LRN (n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention: All patients underwent RN. Measurements: Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations: Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p = 0.4) or disease-specific mortality (p = 0.9). This study is limited by its retrospective nature. Conclusions: Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.

Original languageEnglish (US)
Pages (from-to)645-651
Number of pages7
JournalEuropean Urology
Volume58
Issue number5
DOIs
StatePublished - Nov 1 2010

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Recurrence
Survival
Urinary Bladder
Confidence Intervals
Carcinoma
Standard of Care
Proportional Hazards Models
Urinary Bladder Neoplasms
Disease-Free Survival
Retrospective Studies
Lymph Nodes
Neoplasm Metastasis
Kidney
Safety
Mortality
Incidence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Favaretto, Ricardo L. ; Shariat, Shahrokh F. ; Chade, Daher C. ; Godoy, Guilherme ; Kaag, Matthew G. ; Cronin, Angel M. ; Bochner, Bernard H. ; Coleman, Jonathan ; Dalbagni, Guido. / Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients : Are recurrence and disease-specific survival associated with surgical technique?. In: European Urology. 2010 ; Vol. 58, No. 5. pp. 645-651.
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title = "Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: Are recurrence and disease-specific survival associated with surgical technique?",
abstract = "Background: Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective: Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants: We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n = 109) or LRN (n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention: All patients underwent RN. Measurements: Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations: Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38{\%} and 42{\%}, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95{\%} confidence interval [CI], 0.57-1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95{\%} CI, 0.46-1.34; p = 0.4) or disease-specific mortality (p = 0.9). This study is limited by its retrospective nature. Conclusions: Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.",
author = "Favaretto, {Ricardo L.} and Shariat, {Shahrokh F.} and Chade, {Daher C.} and Guilherme Godoy and Kaag, {Matthew G.} and Cronin, {Angel M.} and Bochner, {Bernard H.} and Jonathan Coleman and Guido Dalbagni",
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Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients : Are recurrence and disease-specific survival associated with surgical technique? / Favaretto, Ricardo L.; Shariat, Shahrokh F.; Chade, Daher C.; Godoy, Guilherme; Kaag, Matthew G.; Cronin, Angel M.; Bochner, Bernard H.; Coleman, Jonathan; Dalbagni, Guido.

In: European Urology, Vol. 58, No. 5, 01.11.2010, p. 645-651.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients

T2 - Are recurrence and disease-specific survival associated with surgical technique?

AU - Favaretto, Ricardo L.

AU - Shariat, Shahrokh F.

AU - Chade, Daher C.

AU - Godoy, Guilherme

AU - Kaag, Matthew G.

AU - Cronin, Angel M.

AU - Bochner, Bernard H.

AU - Coleman, Jonathan

AU - Dalbagni, Guido

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective: Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants: We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n = 109) or LRN (n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention: All patients underwent RN. Measurements: Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations: Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p = 0.4) or disease-specific mortality (p = 0.9). This study is limited by its retrospective nature. Conclusions: Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.

AB - Background: Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective: Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants: We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n = 109) or LRN (n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention: All patients underwent RN. Measurements: Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations: Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p = 0.4) or disease-specific mortality (p = 0.9). This study is limited by its retrospective nature. Conclusions: Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.

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