Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Eur Urol. 2012 Apr;61(4):715-21. doi: 10.1016/j.eururo.2011.12.026. Epub 2011 Dec 22.
Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort.
Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort.
DESIGN, SETTING, AND PARTICIPANTS: We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients.
All patients underwent NU.
The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching.
For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p<0.001); intraoperative complications, 4.7% versus 2.1% (p=0.002); postoperative complications, 17% versus 15% (p=0.24); pLOS (≥5 d), 47% versus 28% (p<0.001); in-hospital mortality, 1.3% versus 0.7% (p=0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p<0.001), to experience any intraoperative complications (OR: 0.4; p=0.002), and to have a pLOS (OR: 0.4; p<0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p=0.007). This study is limited by its retrospective nature.
After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU.
肾输尿管切除术（NU）是治疗非转移性上尿路尿路上皮癌（UTUC）患者的主要方法。可以选择开放性 NU（ONU）或腹腔镜 NU（LNU）。尽管有多项研究比较了两种方法的围手术期和癌症控制结果，但没有一项研究依赖于基于人群的队列。
在基于人群的队列中检查 ONU 和 LNU 的术中及术后发病率。
设计、设置和参与者：我们依赖于美国全国住院患者样本（NIS）来识别 1998 年至 2009 年间接受 ONU 或 LNU 治疗的非转移性 UTUC 患者。总体而言，7401 例（90.8%）和 754 例（9.2%）患者分别接受了 ONU 和 LNU。为了调整两组之间潜在的基线差异，进行了基于倾向评分的匹配。这导致 3016 例（80%）ONU 患者与 754 例（20%）LNU 患者匹配。
所有患者均接受 NU。
评估两种手术的术中及术后并发症、输血、延长住院时间（pLOS）和院内死亡率。在倾向评分匹配后，在队列中进行多变量逻辑回归分析。
ONU 与 LNU 相比，分别记录了以下比率：输血，15%比 10%（p<0.001）；术中并发症，4.7%比 2.1%（p=0.002）；术后并发症，17%比 15%（p=0.24）；pLOS（≥5d），47%比 28%（p<0.001）；院内死亡率，1.3%比 0.7%（p=0.12）。在多变量逻辑回归分析中，LNU 患者输血的可能性较小（比值比[OR]：0.6；p<0.001），发生任何术中并发症的可能性较小（OR：0.4；p=0.002），且 pLOS 的可能性较小（OR：0.4；p<0.001）。总体而言，术后并发症相当。然而，LNU 患者的呼吸系统并发症较少（OR：0.4；p=0.007）。本研究受到其回顾性的限制。
在调整潜在选择偏倚后，LNU 与 ONU 相比，术中及围手术期不良结果较少。
