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Open Access 01-12-2021 | Urothelial Cancer | Review

Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis

Authors: Radosław Piszczek, Łukasz Nowak, Wojciech Krajewski, Joanna Chorbińska, Sławomir Poletajew, Marco Moschini, Krzysztof Kaliszewski, Romuald Zdrojowy

Published in: World Journal of Surgical Oncology | Issue 1/2021

Abstract

Background

During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU.

Materials and methods

The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled.

Results

Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60–1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62–1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85–1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94–1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter.

Conclusions

Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.

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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.CrossRef

Collà RC, Nocera L, Stolzenbach LF, Wenzel M, Cucchiara V, Tian Z, et al. Incidence and survival rates of contemporary patients with invasive upper tract urothelial carcinoma. Eur Urol Oncol. 2020;S2588-9311(20):30181–4. https://doi.org/10.1016/j.euo.2020.11.005.CrossRef

Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021;79(1):62–79. https://doi.org/10.1016/j.eururo.2020.05.042.

Leow JJ, Liu Z, Tan TW, Lee YM, Yeo EK, Chong YL. Optimal management of upper tract urothelial carcinoma: current perspectives. Onco Targets Ther. 2020;13:1–15. https://doi.org/10.2147/OTT.S225301.CrossRefPubMedPubMedCentral

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. https://doi.org/10.1016/j.eururo.2009.06.013.

Liu F, Guo W, Zhou X, Ding Y, Ma Y, Hou Y, et al. Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97:e11954. https://doi.org/10.1097/MD.0000000000011954.CrossRef

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane; 2020. Available from www.training.cochrane.org/handbook. (Accessed 15 Nov 2020)

Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. (Accessed 15 Nov 2020)

10.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4.CrossRefPubMed

11.

Ariane MM, Colin P, Ouzzane A, Pignot G, Audouin M, Cornu JN, et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol. 2012;19(1):301–8. https://doi.org/10.1245/s10434-011-1841-x.

12.

Azawi NH, Næraa SH, Subhi Y, Vásquez JL, Norus T, Dahl C, et al. Oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in Denmark. Scand J Urol. 2020;54(1):58–64. https://doi.org/10.1080/21681805.2019.1710562.

13.

Capitanio U, Shariat SF, Isbarn H, Weizer A, Remzi M, Roscigno M, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009;56(1):1–9. https://doi.org/10.1016/j.eururo.2009.03.072.

14.

Fairey AS, Kassouf W, Estey E, Tanguay S, Rendon R, Bell D, et al. Comparison of oncological outcomes for open and laparoscopic radical nephroureterectomy: results from the Canadian Upper Tract Collaboration. BJU Int. 2013;112(6):791–7. https://doi.org/10.1111/j.1464-410X.2012.11474.x.

15.

Favaretto RL, Shariat SF, Chade DC, Godoy G, Kaag M, Cronin AM, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol. 2010;58(5):645–51. https://doi.org/10.1016/j.eururo.2010.08.005.

16.

Fradet V, Mauermann J, Kassouf W, Rendon R, Jacobsen N, Fairey A, et al. Risk factors for bladder cancer recurrence after nephroureterectomy for upper tract urothelial tumors: results from the Canadian Upper Tract Collaboration. Urol Oncol. 2014;32(6):839–45. https://doi.org/10.1016/j.urolonc.2014.04.006.

17.

Kido K, Hatakeyama S, Fujita N, Yamamoto H, Tobisawa Y, Yoneyama T, et al. Oncologic outcomes for open and laparoscopic radical nephroureterectomy in patients with upper tract urothelial carcinoma. Int J Clin Oncol. 2018;23(4):726–33. https://doi.org/10.1007/s10147-018-1248-9.

18.

Kim HS, Ku JH, Jeong CW, Kwak C, Kim HH. Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol. 2016;34(6):859–69. https://doi.org/10.1007/s00345-015-1712-3.CrossRefPubMed

19.

Kim SH, Song MK, Kim JK, Hong B, Kang SH, Ku JH, et al. Laparoscopy versus open nephroureterectomy in prognostic outcome of patients with advanced upper tract urothelial cancer: a retrospective, multicenter, propensity-score matching analysis. Cancer Res Treat. 2019;51(3):963–72. https://doi.org/10.4143/crt.2018.465.

20.

Kitamura H, Maeda T, Tanaka T, Fukuta F, Kobayashi K, Nishiyama N, et al. Comparison of laparoscopic, hand-assisted, and open surgical nephroureterectomy. JSLS. 2014;18(2):288–93. https://doi.org/10.4293/108680813X13794522666842.

21.

Koda S, Mita K, Shigeta M, Usui T. Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery. Jpn J Clin Oncol. 2007;37(4):296–301. https://doi.org/10.1093/jjco/hym016.CrossRefPubMed

22.

Lee H, Kim HJ, Lee SE, Hong SK, Byun SS. 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(1):e0210401. https://doi.org/10.1371/journal.pone.0210401.CrossRefPubMedPubMedCentral

23.

Lenis AT, Donin NM, Faiena I, Salmasi A, Johnson DC, Drakaki A, et al. Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma. Urol Oncol. 2018;36(9):e1–9.e9. https://doi.org/10.1016/j.urolonc.2017.09.001.CrossRef

24.

Moschini M, Zamboni S, Afferi L, Pradere B, Abufaraj M, Soria F, et al. Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: a propensity score-matched analysis [published online ahead of print, 2020 Jun 24]. Arab J Urol. 19(1):31–6. https://doi.org/10.1080/2090598X.2020.1817720.

25.

Shigeta K, Kikuchi E, Abe T, Hagiwara M, Ogihara K, Anno T, et al. Long-term oncologic outcomes of laparoscopic versus open radical nephroureterectomy for patients with T3N0M0 upper tract urothelial carcinoma: a multicenter cohort study with adjustment by propensity score matching. Ann Surg Oncol. 2019;26(11):3774–81. https://doi.org/10.1245/s10434-019-07623-1.

26.

Taweemonkongsap T, Nualyong C, Amornvesukit T, Leewansangtong S, Srinualnad S, Chaiyaprasithi B, et al. Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: comparison of retroperitoneoscopic and open nephroureterectomy. World J Surg Oncol. 2008;6(1):3. https://doi.org/10.1186/1477-7819-6-3.

27.

Walton TJ, Novara G, Matsumoto K, Kassouf W, Fritsche HM, Artibani W, et al. Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int. 2011;108(3):406–12. https://doi.org/10.1111/j.1464-410X.2010.09826.x.

28.

Sugihara T, Yasunaga H, Yu C, Horiguchi H, Nishimatsu H, Fushimi K, et al. Perioperative outcome comparisons between open and laparoscopic nephroureterectomy among a population-based cohort from 2010 to 2012. J Endourol. 2015;29(7):770–6. https://doi.org/10.1089/end.2014.0428.

29.

Hanna N, Sun M, Trinh QD, Hansen J, Bianchi M, Montorsi F, et al. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol. 2012;61(4):715–21. https://doi.org/10.1016/j.eururo.2011.12.026.

30.

Rouprêt M, Smyth G, Irani J, Guy L, Davin JL, Saint F, et al. Oncological risk of laparoscopic surgery in urothelial carcinomas. World J Urol. 2009;27(1):81–8. https://doi.org/10.1007/s00345-008-0349-x.

31.

Braun AE, Srivastava A, Maffucci F, Kutikov A. Controversies in management of the bladder cuff at nephroureterectomy. Transl Androl Urol. 2020;9:1868–80. https://doi.org/10.21037/tau.2020.01.17.CrossRefPubMedPubMedCentral

32.

Shigeta K, Matsumoto K, Takeda T, Hattori S, Kaneko G, Matsushima M, et al. Evaluating the oncological outcomes of pure laparoscopic radical nephroureterectomy performed for upper-tract urothelial carcinoma patients: a multicenter cohort study adjusted by propensity score matching. Ann Surg Oncol. 2021;28(1):465–73. https://doi.org/10.1245/s10434-020-09046-9.

33.

Leow JJ, Chong YL, Chang SL, Valderrama BP, Powles T, Bellmunt J. Neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma: a 2020 systematic review and meta-analysis, and future perspectives on systemic therapy. Eur Urol. 2020;S0302-2838(20):30532–7. https://doi.org/10.1016/j.eururo.2020.07.003.CrossRef

34.

Margulis V, Puligandla M, Trabulsi EJ, Plimack ER, Kessler ER, Matin SF, et al. Phase II trial of neoadjuvant systemic chemotherapy followed by extirpative surgery in patients with high grade upper tract urothelial carcinoma. J Urol. 2020;203(4):690–8. https://doi.org/10.1097/JU.0000000000000644.CrossRefPubMed

35.

Ni S, Tao W, Chen Q, Liu L, Jiang H, Hu H, et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2012;61(6):1142–53. https://doi.org/10.1016/j.eururo.2012.02.019.

36.

Zhang S, Luo Y, Wang C, Fu SJ, Yang L. Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis. PeerJ. 2016;4:e2063. https://doi.org/10.7717/peerj.2063.CrossRefPubMedPubMedCentral

37.

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. https://doi.org/10.1016/j.euf.2017.10.003.

Title: Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis
Authors: Radosław Piszczek
Łukasz Nowak
Wojciech Krajewski
Joanna Chorbińska
Sławomir Poletajew
Marco Moschini
Krzysztof Kaliszewski
Romuald Zdrojowy
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Urothelial Cancer
Urothelial Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2021
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-021-02236-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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