Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis
https://doi.org/10.4081/aiua.2021.4.408
Accepted: October 13, 2021
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Purpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach.
Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance.
Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m2 and in group 2 25.20 kg/m2. Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 3.3 days p = 0.006).
Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; 69:7-34. DOI: https://doi.org/10.3322/caac.21551
Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115:1224-33. DOI: https://doi.org/10.1002/cncr.24135
Rouprêt M, Babjuk M, Compérat E, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 Update. Eur Urol. 2018; 73:111-22. DOI: https://doi.org/10.1016/j.eururo.2017.07.036
Nouralizadeh A, Tabatabaei S, Basiri A, et al. Comparison of open versus laparoscopic versus hand-assisted laparoscopic nephroureterectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2018; 28:656-81. DOI: https://doi.org/10.1089/lap.2017.0662
Mullen E, Ahmed K, Challacombe B. Systematic review of open versus laparoscopic versus robot-assisted nephroureterectomy. Rev Urol. 2017; 19:32-43.
Lee H, Kim HJ, Lee SE, et al. Comparison of oncological and perioperative outcomes of open, laparoscopic, and robotic nephroureterectomy approaches in patients with non-metastatic upper-tract urothelial carcinoma. PLoS One. 2019; 14:e0210401. DOI: https://doi.org/10.1371/journal.pone.0210401
Hu CY, Yang CK, Huang CY, et al. Robot-assisted laparoscopic nephroureterectomy versus hand-assisted laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a matched comparison study. BioMed Res Int. 2015; 2015:918486. DOI: https://doi.org/10.1155/2015/918486
Campi R, Cotte J, Sessa F, et al. Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol. 2019; 37:2303-11. DOI: https://doi.org/10.1007/s00345-019-02790-y
Argun OB, Mourmouris P, Tufek I, et al. Radical nephroureterectomy without patient or port repositioning using the Da Vinci Xi robotic system: initial experience. Urology. 2016; 92:136-9. DOI: https://doi.org/10.1016/j.urology.2016.02.047
Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010; 57:963-9. DOI: https://doi.org/10.1016/j.eururo.2009.12.032
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205-13. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
Rose K, Khan S, Godbole H, et al. Robotic assisted retroperitoneoscopic nephroureterectomy -- first experience and the hybrid port technique. Int J Clin Pract. 2006; 60:12-4. DOI: https://doi.org/10.1111/j.1368-5031.2006.00703.x
Nanigian DK, Smith W, Ellison LM. Robot-assisted laparoscopic nephroureterectomy. J Endourol. 2006; 20:463-5. DOI: https://doi.org/10.1089/end.2006.20.463
Park SY, Jeong W, Ham WS, et al. Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int. 2009;104:1718-21. DOI: https://doi.org/10.1111/j.1464-410X.2009.08671.x
Pugh J, Parekattil S, Willis D, et al. Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series. BJU Int. 2013; 112:E295-300. DOI: https://doi.org/10.1111/bju.12163
Zargar H, Krishnan J, Autorino R, et al. Robotic nephroureterectomy: a simplified approach requiring no patient repositioning or robot redocking. Eur Urol. 2014; 66:769-77. DOI: https://doi.org/10.1016/j.eururo.2014.02.060
Aboumohamed AA, Krane LS, Hemal AK. Oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma. J Urol. 2015;194:1561-6. DOI: https://doi.org/10.1016/j.juro.2015.07.081
De Groote R, Decaestecker K, Larcher A, et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions. J Robot Surg. 2020; 14:211-9. DOI: https://doi.org/10.1007/s11701-019-00965-8
Patel MN, Aboumohamed A, Hemal A. Does transition from the da Vinci Si to Xi robotic platform impact single-docking technique for robot-assisted laparoscopic nephroureterectomy? BJU Int. 2015;116:990-4. DOI: https://doi.org/10.1111/bju.13210
Rodriguez JF, Packiam VT, Boysen WR, et al. Utilization and outcomes of nephroureterectomy for upper tract urothelial carcinoma by surgical approach. J Endourol. 2017; 31:661-5. DOI: https://doi.org/10.1089/end.2017.0086
Tinay I, Gelpi-Hammerschmidt F, Leow JJ. Trends in utilisation, perioperative outcomes, and costs of nephroureterectomies in the management of upper tract urothelial carcinoma: a 10-year population-based analysis. BJU Int. 2016; 117:954-60. DOI: https://doi.org/10.1111/bju.13375
Pearce SM, Pariser JJ, Patel SG, et al. The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. Urol Oncol. 2016; 34:121.e15-21. DOI: https://doi.org/10.1016/j.urolonc.2015.09.008
Tafuri A, Odorizzi K, Di Filippo G, et al. Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience. Arch Ital Urol Androl. 2021;93:9-14. DOI: https://doi.org/10.4081/aiua.2021.1.9
Veccia A, Antonelli A, Francavilla S, et al. Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87.000 cases. World J Urol. 2020; 38:845-52. DOI: https://doi.org/10.1007/s00345-019-03020-1
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
