Robotic Radical Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma: A Trend Analysis of Utilization and a Comparative Study

Simple Summary Robotic radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma has only recently started to increase in Korea. The use of robotic RNU has been steadily increasing from 9% in 2017 to 67% in 2021 in our institution and replacing open and laparoscopic RNU. Perioperative outcomes including operation time, blood loss, and the length of hospital stay were not different between the robotic, open, and laparoscopic RNU groups. The 90-day complications did not differ significantly between the three groups. The three-year overall survival (OS) rates for open, laparoscopic, and robotic RNU were 91.8%, 90.4%, and 92.1%, respectively (p > 0.05). No differences in the intravesical recurrence-free survival, progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were observed according to the surgical approach in the Kaplan-Meier survival analysis. Multivariate analysis showed that the surgical approach of RNU was not an independent predictor of PFS, CSS, and OS. Purpose: To compare the perioperative outcomes and oncological results of open, laparoscopic, and robotic radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) and to analyze trends in the utilization of RNU. Methods: From 2017 to 2020, the records of 61, 185, and 119 patients who underwent open, laparoscopic, and robotic RNU, respectively, were reviewed. Results: Baseline characteristics were not significantly different among the three groups. Robotic RNU has recently started to increase from 9% in 2017 to 67% in 2021. Operation time, blood loss, length of hospital stay, and 90-day complications were not different between the three groups. The three-year overall survival (OS) rates for open, laparoscopic, and robotic RNU were 91.8%, 90.4%, and 92.1%, respectively (p > 0.05). No differences in the progression-free survival (PFS), cancer-specific survival (CSS), and OS were observed according to the surgical approach in the Kaplan-Meier survival analysis. Multivariate analysis showed that surgical approach was not an independent predictor of PFS, CSS, and OS. Conclusion: The use of robotic RNU in patients with UTUC has been starting to increase and replace open and laparoscopic RNU. Perioperative outcomes, 90-day complications, and oncological outcomes of robotic RNU were not inferior to those of open and laparoscopic RNU.

Automated summary

Robotic radical nephroureterectomy (RNU) has been increasingly used for patients with upper tract urothelial carcinoma in Korea, replacing open and laparoscopic RNU. The perioperative outcomes, 90-day complications, and oncological outcomes of robotic RNU were comparable to open and laparoscopic RNU. There were no significant differences in overall survival, progression-free survival, and cancer-specific survival between the surgical approaches.