Laparoscopy versus open nephroureterectomy in prognostic outcome of patients with advanced upper tract urothelial cancer: A retrospective, multicenter, propensity-score matching analysis

Sung Han Kim, Mi Kyung Song, Jung Kwon Kim, Bumsik Hong, Seok Ho Kang, Ja Hyeon Ku, Byong Chang Jeong, Ho Kyung Seo

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Purpose The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma. Materials and Methods The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Society of Anesthesiologists score, tumor location, grade, pathologic T and N categories, the presence of lymphovascular invasion, and follow-up duration. The Kaplan-Meier with log-rank tests and clustered Cox regression were used to compare the estimated rates of survival for each surgical approach and to investigate the effect of the surgical approach on each prognostic outcome. Results Six hundred thirty-eight propensity-score matching pairs (n=1,276) were compared; LNU was significantly better than ONU in all types of survival, including intravesical recurrence-free survival (IVRFS), disease-free survival, overall survival (OS), and cancer-specific survival (CSS) (p < 0.05). The 3-year OS and CSS rates were significantly higher with LNU than with ONU (p < 0.05). Compared with ONU, LNU had significantly better 3-year OS and CSS rates (82.9% and 86.2% vs. 78.3% and 81.8%); there were no differences at 5 years. In subgroup analysis of the early-staged group, advanced-stage group, lymph node–positive group, and lymph node–negative group, the two approaches did not significantly affect prognostic outcomes, except LNU improved the IVRFS in the lymph node–negative or no history of previous bladder cancer group. Conclusion LNU had a significantly better prognostic outcome than ONU after propensity-score matching.

Original languageEnglish
Pages (from-to)963-972
Number of pages10
JournalCancer Research and Treatment
Volume51
Issue number3
DOIs
Publication statusPublished - 2019 Jul 1

Keywords

  • Laparoscopy
  • Nephroureterectomy
  • Prognosis
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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