Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Centre de recherche du Centre Hospitalier de l'Université de Montréal, Institut du cancer de Montréal, Montreal, Quebec, Canada.
Int J Urol. 2019 Apr;26(4):487-492. doi: 10.1111/iju.13916. Epub 2019 Feb 12.
To examine intraoperative and postoperative morbidity and mortality, as well as the impact on length of stay and total hospital charges of minimally invasive nephroureterectomy compared with open nephroureterectomy in patients with upper tract urothelial carcinoma.
Within the National Inpatient Sample (2008-2013), we identified patients with non-metastatic upper tract urothelial carcinoma treated with either minimally invasive nephroureterectomy or open nephroureterectomy. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between open nephroureterectomy versus minimally invasive nephroureterectomy. Multivariable logistic regression, multivariable Poisson regression models and multivariable linear regression models were used.
Between 2008 and 2013, we identified 3897 patients treated with either minimally invasive nephroureterectomy (1093 [28%]) or open nephroureterectomy (2804 [72%]). In multivariable logistic regression models, minimally invasive nephroureterectomy resulted in lower rates of overall (odds ratio 0.71, P < 0.001), wound (odds ratio 0.49, P = 0.01), intraoperative (odds ratio 0.55, P = 0.01), miscellaneous surgical (odds ratio 0.64, P = 0.008) and miscellaneous medical complications (odds ratio 0.77, P = 0.002). Furthermore, minimally invasive nephroureterectomy was associated with lower rates of transfusions (odds ratio 0.61, P < 0.001). In multivariable Poisson regression models, minimally invasive nephroureterectomy was associated with shorter length of stay (relative risk 0.88, P < 0.001). Finally, higher total hospital charges ($2500 more per patient) were recorded for minimally invasive nephroureterectomy.
Intraoperative and postoperative morbidity, as well as length of stay, but not total hospital charges favor minimally invasive nephroureterectomy over open nephroureterectomy. These outcomes validate the safety and feasibility of minimally invasive nephroureterectomy in select upper tract urothelial carcinoma patients.
比较微创肾输尿管切除术与开放肾输尿管切除术治疗上尿路上皮癌患者的术中及术后发病率和死亡率，以及对住院时间和总住院费用的影响。
在国家住院患者样本（2008-2013 年）中，我们确定了接受微创肾输尿管切除术或开放肾输尿管切除术治疗的非转移性上尿路上皮癌患者。我们依靠逆概率治疗加权来降低开放肾输尿管切除术与微创肾输尿管切除术之间固有差异的影响。使用多变量逻辑回归、多变量泊松回归模型和多变量线性回归模型。
2008 年至 2013 年间，我们确定了 3897 例接受微创肾输尿管切除术（1093 例[28%]）或开放肾输尿管切除术（2804 例[72%]）治疗的患者。在多变量逻辑回归模型中，微创肾输尿管切除术的总体并发症发生率较低（比值比 0.71，P<0.001）、切口（比值比 0.49，P=0.01）、术中（比值比 0.55，P=0.01）、杂项手术（比值比 0.64，P=0.008）和杂项医疗并发症（比值比 0.77，P=0.002）。此外，微创肾输尿管切除术与输血率降低相关（比值比 0.61，P<0.001）。在多变量泊松回归模型中，微创肾输尿管切除术与较短的住院时间相关（相对风险 0.88，P<0.001）。最后，微创肾输尿管切除术的总住院费用（每位患者增加 2500 美元）较高。
微创肾输尿管切除术与开放肾输尿管切除术相比，术中及术后发病率、住院时间较短，但总住院费用无差异。这些结果验证了微创肾输尿管切除术在上尿路尿路上皮癌患者中的安全性和可行性。
