Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma A systematic review and meta-analysis

Purpose: To evaluate the efficacy and safety of laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU) for the treatment of upper urinary tract urothelial carcinoma (UTUC). Methods: PubMed, Embase, and Cochrane databases were selected for systematic review of trials that compared outcomes of LNU and ONU. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. Results: LNU was associated with longer operation time (P<.001), shorter hospital stay (P<.001), less blood loss (P=.006) and lower rate of transfusion (P<.001). The occurrence of complications, including minor (P=.52), major (P=.21) and total complications (P=.19) were similar between LNU and ONU. There was no significant difference in the rate of 5-year recurrence-free survival (P=.90), 5-year cancer-specific survival (P=.12), and 5-year overall survival (P=.11) as well as 2-year RFS (P=.84), 2-year CSS (P=.86), and 2-year OS (P=.25). Conclusion: Our results indicated that LNU is a safe and effective method to treat UTUC. Given the limitations of this study, further multicenter, randomized trials are required to confirm these findings.