Department of Urology, China Medical University Hospital, China Medical university, Taichung, Taiwan.
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
BMC Urol. 2024 Oct 21;24(1):231. doi: 10.1186/s12894-024-01622-5.
Nephroureterectomy with bladder cuff excision is the standard treatment for high-risk upper urinary tract urothelial carcinoma (UTUC). The role of minimally invasive surgery in treating locally advanced UTUC remains controversial. This study aimed to compare the outcomes of open, laparoscopic, and robotic surgeries for managing locally advanced UTUC.
We retrospectively reviewed 705 patients with locally advanced UTUC from multiple institutions throughout Taiwan. Perioperative outcomes and oncological outcomes, such as cancer-specific survival, overall survival, disease-free survival and bladder-free survival, were compared between the open, laparoscopic and robotic groups.
The minimally invasive group had better overall and cancer-specific survival (CSS) rates. The 2-year CSS rates of the open, laparoscopic and robotic groups were 71%, 83%, and 77% respectively (p < 0.001). The robotic group had similar outcomes to the laparoscopic group. (p = 0.061, 0.825, 0.341 for OS, CSS, DFS respectively.) More lymph node dissections were performed and more lymph nodes were harvested in the robotic group (p = 0.009).
Our results demonstrated that minimally invasive surgery, including laparoscopic and robotic surgery, for locally advanced UTUC resulted in oncological outcomes that are non-inferior to those of open surgery.
肾输尿管切除术联合膀胱袖状切除术是治疗高危上尿路尿路上皮癌（UTUC）的标准治疗方法。微创手术在治疗局部晚期 UTUC 中的作用仍存在争议。本研究旨在比较开放手术、腹腔镜手术和机器人手术治疗局部晚期 UTUC 的效果。
我们回顾性分析了来自台湾多家机构的 705 例局部晚期 UTUC 患者的资料。比较了开放组、腹腔镜组和机器人组之间的围手术期和肿瘤学结果，如癌症特异性生存率、总生存率、无病生存率和无膀胱生存率。
微创手术组的总体生存率和癌症特异性生存率（CSS）较好。开放组、腹腔镜组和机器人组的 2 年 CSS 率分别为 71%、83%和 77%（p<0.001）。机器人组的结果与腹腔镜组相似（OS、CSS、DFS 的 p 值分别为 0.061、0.825 和 0.341）。机器人组进行了更多的淋巴结清扫，也采集了更多的淋巴结（p=0.009）。
我们的研究结果表明，包括腹腔镜和机器人手术在内的微创手术治疗局部晚期 UTUC 的肿瘤学结果不劣于开放手术。
