Robotic surgery of the urothelial carcinoma of the upper urinary tract single surgeon initial experience, 66 consecutive cases.
RANU
RARC
Segmental ureterectomy
Upper urinary tract carcinoma (UTUC)
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
received:
31
05
2024
accepted:
15
10
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
Robotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results. The study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes. 37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%. Robotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits.
Identifiants
pubmed: 39482641
doi: 10.1186/s12894-024-01629-y
pii: 10.1186/s12894-024-01629-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
238Informations de copyright
© 2024. The Author(s).
Références
Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, et al. European Association of Urology Guidelines on Upper urinary tract Urothelial Carcinoma: 2023 update. Eur Urol. 2023;84(1):49–64.
doi: 10.1016/j.eururo.2023.03.013
pubmed: 36967359
Ribal MJ, Huguet J, Alcaraz A. Oncologic outcomes obtained after laparoscopic, robotic and/or single port nephroureterectomy for upper urinary tract tumours. World J Urol. 2013;31(1):93–107.
doi: 10.1007/s00345-012-0968-0
pubmed: 23097034
Rassweiler JJ, Schulze M, Marrero R, Frede T, Palou Redorta J, Bassi P. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol. 2004;46(6):690–7.
doi: 10.1016/j.eururo.2004.08.006
pubmed: 15548434
Peyronnet B, Seisen T, Dominguez-Escrig JL, Bruins HM, Yuan CY, Lam T, et al. Oncological outcomes of laparoscopic nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: an European Association of Urology Guidelines Systematic Review. Eur Urol Focus. 2019;5(2):205–23.
doi: 10.1016/j.euf.2017.10.003
pubmed: 29154042
Melquist JJ, Redrow G, Delacroix S, Park A, Faria EE, Karam JA, et al. Comparison of single-docking robotic-assisted and traditional laparoscopy for Retroperitoneal Lymph Node Dissection during Nephroureterectomy with bladder cuff excision for Upper-tract Urothelial Carcinoma. Urology. 2016;87:216–23.
doi: 10.1016/j.urology.2015.07.070
pubmed: 26494291
Ambani SN, Weizer AZ, Wolf JS Jr., He C, Miller DC, Montgomery JS. Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience. Urology. 2014;83(2):345–9.
doi: 10.1016/j.urology.2013.07.079
pubmed: 24315310
Ji R, He Z, Fang S, Yang W, Wei M, Dong J, et al. Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies. Front Oncol. 2022;12:964256.
doi: 10.3389/fonc.2022.964256
pubmed: 35992849
pmcid: 9382403
Huang YP, Huang EY, Chung HJ, Tai MC, Huang TH, Wei TC, et al. Is robotic Superior to Laparoscopic Approach for Radical Nephroureterectomy with bladder cuff excision in treating Upper urinary tract Urothelial Carcinoma? J Endourol. 2023;37(2):139–46.
doi: 10.1089/end.2022.0154
pubmed: 36267017
Simone G, Papalia R, Guaglianone S, Ferriero M, Leonardo C, Forastiere E, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009;56(3):520–6.
doi: 10.1016/j.eururo.2009.06.013
pubmed: 19560259
Hemal AK, Kumar A, Gupta NP, Seth A. Retroperitoneal nephroureterectomy with excision of cuff of the bladder for upper urinary tract transitional cell carcinoma: comparison of laparoscopic and open surgery with long-term follow-up. World J Urol. 2008;26(4):381–6.
doi: 10.1007/s00345-008-0265-0
pubmed: 18431579
Inokuchi J, Kuroiwa K, Kakehi Y, Sugimoto M, Tanigawa T, Fujimoto H, et al. Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A. World J Urol. 2017;35(11):1737–44.
doi: 10.1007/s00345-017-2049-x
pubmed: 28508102
Dominguez-Escrig JL, Peyronnet B, Seisen T, Bruins HM, Yuan CY, Babjuk M, et al. Potential benefit of Lymph Node Dissection during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: a systematic review by the European Association of Urology Guidelines Panel on non-muscle-invasive bladder Cancer. Eur Urol Focus. 2019;5(2):224–41.
doi: 10.1016/j.euf.2017.09.015
pubmed: 29158169
Seisen T, Shariat SF, Cussenot O, Peyronnet B, Renard-Penna R, Colin P, et al. Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. 2017;35(4):535–48.
doi: 10.1007/s00345-016-1764-z
pubmed: 26809456
Yoo S, You D, Jeong IG, Hong B, Hong JH, Ahn H, et al. Does lymph node dissection during nephroureterectomy affect oncological outcomes in upper tract urothelial carcinoma patients without suspicious lymph node metastasis on preoperative imaging studies? World J Urol. 2017;35(4):665–73.
doi: 10.1007/s00345-016-1918-z
pubmed: 27502934
Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M, et al. Oncologic outcomes of kidney-sparing surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: a systematic review by the EAU non-muscle invasive bladder Cancer guidelines Panel. Eur Urol. 2016;70(6):1052–68.
doi: 10.1016/j.eururo.2016.07.014
pubmed: 27477528
De Groote R, Decaestecker K, Larcher A, Buelens S, De Bleser E, D’Hondt F, et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions. J Robot Surg. 2020;14(1):211–9.
doi: 10.1007/s11701-019-00965-8
pubmed: 31041588
Trudeau V, Gandaglia G, Shiffmann J, Popa I, Shariat SF, Montorsi F, et al. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: a population-based assessment of costs and perioperative outcomes. Can Urol Assoc J. 2014;8(9–10):E695–701.
doi: 10.5489/cuaj.2051
pubmed: 25408809
pmcid: 4216301
Yajima S, Nakanishi Y, Yasujima R, Hirose K, Sekiya K, Umino Y, et al. Simultaneous robot-assisted nephroureterectomy and radical cystectomy. IJU Case Rep. 2023;6(1):14–7.
doi: 10.1002/iju5.12534
pubmed: 36605684
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Veccia A, Carbonara U, Djaladat H, Mehazin R, Eun DD, Reese AC, et al. Robotic vs laparoscopic nephroureterectomy for Upper Tract Urothelial Carcinoma: a Multicenter propensity-score matched pair tetrafecta analysis (ROBUUST Collaborative Group). J Endourol. 2022;36(6):752–9.
doi: 10.1089/end.2021.0587
pubmed: 35019760
Wu Z, Chen Q, Djaladat H, Minervini A, Uzzo RG, Sundaram CP, et al. A preoperative Nomogram to predict renal function insufficiency for cisplatin-based Adjuvant Chemotherapy following minimally invasive Radical Nephroureterectomy (ROBUUST Collaborative Group). Eur Urol Focus. 2022;8(1):173–81.
doi: 10.1016/j.euf.2021.01.014
pubmed: 33549537
Campi R, Cotte J, Sessa F, Seisen T, Tellini R, Amparore D, et al. Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol. 2019;37(11):2303–11.
doi: 10.1007/s00345-019-02790-y
pubmed: 31062121
O’Sullivan NJ, Naughton A, Temperley HC, Casey RG. Robotic-assisted versus laparoscopic nephroureterectomy; a systematic review and meta-analysis. BJUI Compass. 2023;4(3):246–55.
doi: 10.1002/bco2.208
pubmed: 37025468
pmcid: 10071076
Hung AJ, Oh PJ, Chen J, Ghodoussipour S, Lane C, Jarc A, et al. Experts vs super-experts: differences in automated performance metrics and clinical outcomes for robot-assisted radical prostatectomy. BJU Int. 2019;123(5):861–8.
doi: 10.1111/bju.14599
pubmed: 30358042
Hung AJ, Chen J, Jarc A, Hatcher D, Djaladat H, Gill IS. Development and Validation of Objective Performance Metrics for Robot-assisted radical prostatectomy: a pilot study. J Urol. 2018;199(1):296–304.
doi: 10.1016/j.juro.2017.07.081
pubmed: 28765067
Kamei J, Fujisaki A, Saito K, Sugihara T, Ando S, Miyagawa T, et al. Less invasive and equivalent short-term outcomes with simultaneous en bloc robot-assisted radical cystectomy and laparoscopic nephroureterectomy: comparison with conventional open radical cystectomy and nephroureterectomy. Asian J Endosc Surg. 2022;15(2):255–60.
doi: 10.1111/ases.12989
pubmed: 34605189
Hakimi K, Carbonara U, Djaladat H, Mehrazin R, Eun D, Reese A, et al. Outcomes of Lymph Node Dissection in Nephroureterectomy in the treatment of Upper Tract Urothelial Carcinoma: analysis of the ROBUUST Registry. J Urol. 2022;208(2):268–76.
doi: 10.1097/JU.0000000000002690
pubmed: 35377778
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1–7.
doi: 10.1097/SLA.0b013e318296c732
pubmed: 23728278
Vetterlein MW, Klemm J, Gild P, Bradtke M, Soave A, Dahlem R, et al. Improving estimates of Perioperative Morbidity after Radical Cystectomy using the European Association of Urology Quality Criteria for Standardized Reporting and introducing the Comprehensive Complication Index. Eur Urol. 2020;77(1):55–65.
doi: 10.1016/j.eururo.2019.08.011
pubmed: 31473012
Mendrek M, Witt JH, Sarychev S, Liakos N, Addali M, Wagner C, et al. Reporting and grading of complications for intracorporeal robot-assisted radical cystectomy: an in-depth short-term morbidity assessment using the novel Comprehensive Complication Index(
doi: 10.1007/s00345-022-04051-x
pubmed: 35670880
Liedberg F, Abrahamsson J, Bobjer J, Gudjonsson S, Löfgren A, Nyberg M, et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma-feasibility and complications: a single center experience. Scand J Urol. 2022;56(4):301–7.
doi: 10.1080/21681805.2022.2091018
pubmed: 35736556
Yong C, Slaven JE, Wu Z, Margulis V, Djaladat H, Antonelli A et al. The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: an analysis of the ROBUUST 2.0 registry. Urol Oncol. 2024;42(11): 373.e1-e7
Ditonno F, Franco A, Veccia A, Bologna E, Wang L, Abdollah F, et al. Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group). Minerva Urol Nephrol. 2024;76(3):331–9.
doi: 10.23736/S2724-6051.24.05737-9
pubmed: 38920013
Busch C, Algaba F. The WHO/ISUP 1998 and WHO 1999 systems for malignancy grading of bladder cancer. Scientific foundation and translation to one another and previous systems. Virchows Arch. 2002;441(2):105–8.
doi: 10.1007/s00428-002-0633-x
pubmed: 12189498