Rodriguez Joseph F, Packiam Vignesh T, Boysen William R, Johnson Scott C, Smith Zachary L, Smith Norm D, Shalhav Arieh L, Steinberg Gary D
Department of Surgery, Section of Urology, University of Chicago , Chicago, Illinois.
J Endourol. 2017 Jul;31(7):661-665. doi: 10.1089/end.2017.0086. Epub 2017 Jun 20.
To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data.
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).
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.
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.
利用基于人群的数据比较开放性、机器人辅助和腹腔镜肾输尿管切除术（ONU、RNU、LNU）的手术结果和生存率。
使用国家癌症数据库，我们确定了2010年至2013年间因局限性上尿路尿路上皮癌接受肾输尿管切除术的患者。比较了三种手术方式的人口统计学和临床病理特征。采用多因素回归分析确定手术方式对淋巴结清扫术（LND）、手术切缘阳性（PSM）和总生存率（OS）的影响。
总共确定了9401例病例进行分析，包括3199例ONU（34%）、2098例RNU（22%）和4104例LNU（44%）。从2010年到2013年，RNU的使用率从14%增加到30%。多因素分析显示，与ONU相比，RNU进行LND的可能性更大（比值比[OR]1.52；p<0.01），而LNU进行LND的可能性更小（OR 0.77；p<0.01）。与ONU相比，RNU与PSM降低相关（OR=0.73；p=0.04）。在调整其他因素后，OS与手术方式无显著相关性。
在研究期间，RNU的使用率翻了一番。与ONU和LNU相比，RNU进行LND的可能性更大，PSM率更低，但手术方式并未独立影响OS。
