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Huang J, Qian H, Yuan Y, Cai X, Chen Y, Zhang J, Kong W, Wu X, Cao M, Huang Y, Chen H, Xue W. Prospective Clinical Trial of the Oncologic Outcomes and Safety of Extraperitoneal Laparoscopic Extended Retroperitoneal Lymph Node Dissection at Time of Nephroureterectomy for Upper Tract Urothelial Carcinoma. Front Oncol 2022; 12:791140. [PMID: 35280720 PMCID: PMC8907892 DOI: 10.3389/fonc.2022.791140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the safety and feasibility of extraperitoneal laparoscopic extended lymph node dissection (LND) at the time of extraperitoneal laparoscopic radical nephroureterectomy (RNU). Materials and Methods Between May 2018 and March 2019, 39 patients with upper tract urothelial carcinoma (UTUC) received extraperitoneal laparoscopic RNU and concomitant extraperitoneal laparoscopic extended LND. All patients were followed for at least 90 days. Perioperative and pathological data including nodal status and perioperative complications were collected. Results Among all 39 patients, 12 patients had pT1, 6 had pT2, 20 had pT3 disease, and 1 had T4 disease. The median (range) lymph node count was 10 (5–22), with 8 patients having pathologically proven lymph node metastasis. The median (range) operating time was 225 (165–430) min, and the median estimated blood loss was 200 (60–800) ml. The median postoperative hemoglobin loss was 1.6 (0–4.2) g/dl. The median (range) postoperative hospital stays were 6 (3–26) days. Overall, 7 patients experienced minor (Clavien Grade I–II) postoperative complications with five patients having Clavien Grade I complications and two patients having Clavien Grade II complications. No major complication (Clavien grade III–IV) occurred. With a median follow-up of 38 months, a total of 8 patients (20.5%) developed local or distant recurrence and no regional LNs where extended LND were performed had recurrence. Conclusions The present prospective study demonstrated that extraperitoneal laparoscopic extended LND during extraperitoneal laparoscopic RNU for UTUC is a feasible and safe procedure which provides minimal invasion, rapid recovery, and potentially lower risk of regional LN recurrence. Larger prospective clinical trials with survival endpoints are needed to further determine its potential therapeutic benefits. Trial Registration ClinicalTrials.gov identifier NCT 03544437 www.clinicaltrials.gov
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Affiliation(s)
- Jiwei Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongyang Qian
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yichu Yuan
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingyun Cai
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Kong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaorong Wu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Cao
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haige Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Veccia A, Carbonara U, Djaladat H, Mehrazin R, Eun D, Reese AC, Meng X, Uzzo R, Srivastava A, Porter JR, Farrow J, Jamil M, Rosiello G, Tellini R, Mari A, Al-Qathani A, Rha KH, Wang L, Mastroianni R, Ferro M, De Cobelli O, Hakimi K, Crocerossa F, Ghoreifi A, Cacciamani G, Amit S Bhattu A, Mottrie A, Abdollah F, Minervini A, Wu Z, Simone G, Derweesh IH, Gonzalgo ML, Margulis V, Sundaram CP, Autorino R. Robotic vs laparoscopic nephroureterectomy for upper tract urothelial carcinoma: a multicenter propensity-score matched pair "tetrafecta" analysis (ROBUUST collaborative group). J Endourol 2022; 36:752-759. [PMID: 35019760 DOI: 10.1089/end.2021.0587] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To compare the outcomes of robotic radical nephroureterectomy (RRNU) and laparoscopic radical nephroureterectomy (LRNU) within a large multi-institutional worldwide dataset. MATERIAL AND METHODS The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) includes data from 17 centers worldwide regarding 877 RRNU and LRNU performed between 2015 and 2019. Baseline features, perioperative and oncological outcomes, were included. A 2:1 nearest-neighbor propensity-score matching with a 0.001 caliper was performed. An univariable and a multivariable logistic regression model were built to evaluate the predictors of a composite "tetrafecta" outcome defined as occurrence of bladder cuff excision + LND + no complications + negative surgical margins. RESULTS After matching, 185 RRNU and 91 LRNU were assessed. Patients in the RRNU group were more likely to undergo bladder cuff excision (81.9% vs 63.7%; p<0.001) compared to the LRNU group. A statistically significant difference was found in terms of overall postoperative complications (p=0.003) and length of stay (p<0.001) in favor of RRNU. Multivariable analysis demonstrated that LRNU was an independent predictor negatively associated with achievement of "tetrafecta" (OR: 0.09; p=0.003). CONCLUSIONS In general, RRNU and LRNU offer comparable outcomes. While the rate of overall complications is higher for LRNU in this study population, this is mostly related to low grade complications, and therefore with more limited clinical relevance. RRNU seems to offer shorter hospital stay but this might also be related to the different geographical location of participating centers. Overall, the implementation of robotics might facilitate achievement of a "tetrafecta" outcome as defined in the present study.
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Affiliation(s)
- Alessandro Veccia
- Spedali Civili Hospital, University of Brescia, Department of Urology, Piazzale Spedali Civili 1, Brescia, Italy, 25123;
| | - Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | | | - Reza Mehrazin
- Mount Sinai Health System, 5944, Urology, 5 East 98th St, 6th floor, New York, New York, United States, 10029;
| | - Daniel Eun
- Temple University, Urology, 255 South 17th street, 7th Floor Urology Suite, Philadelphia, Pennsylvania, United States, 19103;
| | - Adam C Reese
- Lewis Katz School of Medicine at Temple University, Urology, 3401 N Broad St., Suite 340, Philadelphia, Pennsylvania, United States, 19140;
| | - Xiaosong Meng
- University of Texas Southwestern Medical Center, Urology, Dallas, Texas, United States;
| | - Robert Uzzo
- Fox Chase Cancer Center, 6565, 333 Cottman Ave, Philadelphia, Pennsylvania, United States, 19111;
| | | | - James Robert Porter
- Swedish Medical Center, Urology, 1101 Madison, Suite 1400, Seattle, Washington, United States, 98104;
| | - Jason Farrow
- Indiana University Health, 22529, Urology, 535 N Barnhill, Suite 150, Indianapolis, Indiana, United States, 46206-1367;
| | | | - Giuseppe Rosiello
- San Raffaele Hospital, 9372, Urology, Via Olgettina, 52, Milano, Italy, 20132;
| | - Riccardo Tellini
- University Hospital Careggi, 18561, Department of Oncologic, Minimally-Invasive Urology and Andrology, Largo Brambilla 3, Florence, Toscana, Italy, 50134;
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100.,University of Florence, Careggi Hospital, Florence, Italy.;
| | | | - Koon Ho Rha
- Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of);
| | - Linhui Wang
- Changzheng Hospital, 56652, Shanghai, Shanghai, China;
| | | | - Matteo Ferro
- Istituto Europeo di Oncologia, 9290, Urology , via ripamonti 435, Milano, Italy, 90020.,Italy;
| | | | | | - Fabio Crocerossa
- Virginia Commonwealth University, 6889, 1200 E Broad St, Richmond, Virginia, United States, 23284-2512;
| | | | - Giovanni Cacciamani
- AOUI Azienda Ospedaliera Universitaria Integrata, Urology, Piazzale Stefani 1, Verona, Italy, 37100;
| | | | - Alexandre Mottrie
- Onze Lieve Vrouwziekenhuis, 37467, Dep. of Urology, Aalst, Belgium, 9300;
| | - Firas Abdollah
- Henry Ford Health System, Vattikuti Urology Institute, Center for Outcomes Research Analytics and Evaluation, 2799 West Grand Boulevard, Detroit, Michigan, United States, 48202;
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134;
| | - Zhenjie Wu
- Changhai hospital, the second military medical university, the department of Urology, Changhai Road NO. 163, Shanghai, Shanghai, China, 200433;
| | - Giuseppe Simone
- Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144.,Italy;
| | - Ithaar H Derweesh
- University of California - San Diego, Urology, La Jolla, California, United States;
| | - Mark L Gonzalgo
- university of Miami, Miller School of Medicine, urology, Miami, Florida, United States;
| | - Vitaly Margulis
- UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390;
| | - Chandru P Sundaram
- Indiana University School of Medicine, Urology, 535 N Barnhill Dr, Suite 420, Indianapolis, Indiana, United States, 46202;
| | - Riccardo Autorino
- Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298;
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