Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

An European Association of Urology Guidelines Systematic Review

Benoit Peyronnet (Corresponding Author), Thomas Seisen, Jose-Luis Dominguez-Escrig, Harman Max Bruins, Cathy Yuhong Yuan, Thomas Lam, Steven Maclennan, James N'dow, Marko Babjuk, Eva Comperat, Richard Zigeuner, Richard J Sylvester, Maximilian Burger, Hugh Mostafid, Bas W G van Rhijn, Paolo Gontero, Joan Palou, Sharokh F Shariat, Morgan Roupret

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

CONTEXT: Most series have suggested better perioperative outcomes of laparoscopic radical nephroureterectomy (RNU) over open RNU. However, the oncological safety of laparoscopic RNU remains controversial.

OBJECTIVE: To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU.

EVIDENCE ACQUISITION: A systematic literature search using the Medline, Embase, and Cochrane databases and clinicaltrial.gov was performed in December 2014 and updated in August 2016. Randomised controlled trials (RCTs) and prospective or retrospective nonrandomised comparative studies comparing the oncological outcomes of any laparoscopic RNU with those of open RNU were included. The primary outcome was cancer-specific survival. The risk of bias (RoB) was assessed using Cochrane RoB tools. A narrative synthesis of the evidence is presented.

EVIDENCE SYNTHESIS: Overall, 42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. Most included studies were retrospective comparative series. Only one RCT was found. RoB and confounding were high in most studies. No study compared the oncological outcomes of robotic RNU with those of open RNU. Bladder cuff excision in laparoscopic groups was performed via an open approach in most studies, with only three studies reporting laparoscopic removal of the bladder cuff. Port-site metastasis rates ranged from 0% to 2.8%. No significant difference in oncological outcomes was reported in most series. However, three studies, including the only RCT, reported significantly poorer oncological outcomes in patients who underwent laparoscopic RNU, especially in the subgroups of patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinoma (UTUC), as well as in instances when the bladder cuff was excised laparoscopically.

CONCLUSIONS: The current available evidence suggests that the oncological outcomes of laparoscopic RNU may be poorer than those of open RNU when bladder cuff is excised laparoscopically and in patients with locally advanced high-risk (pT3/pT4 and/or high-grade) UTUC.

PATIENT SUMMARY: We reviewed the literature comparing the outcomes of two different surgical procedures for the treatment of upper tract urothelial carcinoma. Open radical nephroureterectomy is a surgical procedure in which the kidney is removed through a large incision in the abdomen, while in laparoscopic radical nephroureterectomy, the kidney is removed through a number of small incisions. Our findings suggest that the outcomes of laparoscopic radical nephroureterectomy may be poorer than those of open radical nephroureterectomy, particularly when the bladder cuff is also required to be removed. Laparoscopic radical nephroureterectomy may also be less effective in patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinomas.

Original languageEnglish
Pages (from-to)205-223
Number of pages19
JournalEuropean Urology Focus
Volume5
Issue number2
Early online date15 Nov 2017
DOIs
Publication statusPublished - Mar 2019

Fingerprint

Urinary Bladder
Guidelines
Carcinoma
Randomized Controlled Trials
Kidney
Robotics
Abdomen
Retrospective Studies
Databases
Neoplasm Metastasis
Safety
Survival
Neoplasms
Therapeutics

Keywords

  • Recurrence
  • Survival
  • Ureter
  • Ureteral Neoplasms
  • Upper tract
  • Urothelial carcinoma
  • Laparoscopy
  • Ureteral neoplasms
  • MANAGEMENT
  • UPPER URINARY-TRACT
  • INTRAVESICAL RECURRENCE
  • FOLLOW-UP
  • CANCER
  • ASSISTED RETROPERITONEOSCOPIC NEPHROURETERECTOMY
  • BLADDER-CUFF RESECTION
  • PERIOPERATIVE OUTCOMES
  • OPEN SURGERY
  • TRANSITIONAL-CELL CARCINOMA

ASJC Scopus subject areas

  • Urology

Cite this

Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma : An European Association of Urology Guidelines Systematic Review. / Peyronnet, Benoit (Corresponding Author); Seisen, Thomas; Dominguez-Escrig, Jose-Luis; Bruins, Harman Max; Yuan, Cathy Yuhong; Lam, Thomas; Maclennan, Steven; N'dow, James; Babjuk, Marko; Comperat, Eva; Zigeuner, Richard; Sylvester, Richard J; Burger, Maximilian; Mostafid, Hugh; van Rhijn, Bas W G; Gontero, Paolo; Palou, Joan; Shariat, Sharokh F; Roupret, Morgan.

In: European Urology Focus, Vol. 5, No. 2, 03.2019, p. 205-223.

Research output: Contribution to journalReview article

Peyronnet, B, Seisen, T, Dominguez-Escrig, J-L, Bruins, HM, Yuan, CY, Lam, T, Maclennan, S, N'dow, J, Babjuk, M, Comperat, E, Zigeuner, R, Sylvester, RJ, Burger, M, Mostafid, H, van Rhijn, BWG, Gontero, P, Palou, J, Shariat, SF & Roupret, M 2019, 'Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review', European Urology Focus, vol. 5, no. 2, pp. 205-223. https://doi.org/10.1016/j.euf.2017.10.003
Peyronnet, Benoit ; Seisen, Thomas ; Dominguez-Escrig, Jose-Luis ; Bruins, Harman Max ; Yuan, Cathy Yuhong ; Lam, Thomas ; Maclennan, Steven ; N'dow, James ; Babjuk, Marko ; Comperat, Eva ; Zigeuner, Richard ; Sylvester, Richard J ; Burger, Maximilian ; Mostafid, Hugh ; van Rhijn, Bas W G ; Gontero, Paolo ; Palou, Joan ; Shariat, Sharokh F ; Roupret, Morgan. / Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma : An European Association of Urology Guidelines Systematic Review. In: European Urology Focus. 2019 ; Vol. 5, No. 2. pp. 205-223.
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abstract = "CONTEXT: Most series have suggested better perioperative outcomes of laparoscopic radical nephroureterectomy (RNU) over open RNU. However, the oncological safety of laparoscopic RNU remains controversial.OBJECTIVE: To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU.EVIDENCE ACQUISITION: A systematic literature search using the Medline, Embase, and Cochrane databases and clinicaltrial.gov was performed in December 2014 and updated in August 2016. Randomised controlled trials (RCTs) and prospective or retrospective nonrandomised comparative studies comparing the oncological outcomes of any laparoscopic RNU with those of open RNU were included. The primary outcome was cancer-specific survival. The risk of bias (RoB) was assessed using Cochrane RoB tools. A narrative synthesis of the evidence is presented.EVIDENCE SYNTHESIS: Overall, 42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. Most included studies were retrospective comparative series. Only one RCT was found. RoB and confounding were high in most studies. No study compared the oncological outcomes of robotic RNU with those of open RNU. Bladder cuff excision in laparoscopic groups was performed via an open approach in most studies, with only three studies reporting laparoscopic removal of the bladder cuff. Port-site metastasis rates ranged from 0{\%} to 2.8{\%}. No significant difference in oncological outcomes was reported in most series. However, three studies, including the only RCT, reported significantly poorer oncological outcomes in patients who underwent laparoscopic RNU, especially in the subgroups of patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinoma (UTUC), as well as in instances when the bladder cuff was excised laparoscopically.CONCLUSIONS: The current available evidence suggests that the oncological outcomes of laparoscopic RNU may be poorer than those of open RNU when bladder cuff is excised laparoscopically and in patients with locally advanced high-risk (pT3/pT4 and/or high-grade) UTUC.PATIENT SUMMARY: We reviewed the literature comparing the outcomes of two different surgical procedures for the treatment of upper tract urothelial carcinoma. Open radical nephroureterectomy is a surgical procedure in which the kidney is removed through a large incision in the abdomen, while in laparoscopic radical nephroureterectomy, the kidney is removed through a number of small incisions. Our findings suggest that the outcomes of laparoscopic radical nephroureterectomy may be poorer than those of open radical nephroureterectomy, particularly when the bladder cuff is also required to be removed. Laparoscopic radical nephroureterectomy may also be less effective in patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinomas.",
keywords = "Recurrence, Survival, Ureter, Ureteral Neoplasms, Upper tract, Urothelial carcinoma, Laparoscopy, Ureteral neoplasms, MANAGEMENT, UPPER URINARY-TRACT, INTRAVESICAL RECURRENCE, FOLLOW-UP, CANCER, ASSISTED RETROPERITONEOSCOPIC NEPHROURETERECTOMY, BLADDER-CUFF RESECTION, PERIOPERATIVE OUTCOMES, OPEN SURGERY, TRANSITIONAL-CELL CARCINOMA",
author = "Benoit Peyronnet and Thomas Seisen and Jose-Luis Dominguez-Escrig and Bruins, {Harman Max} and Yuan, {Cathy Yuhong} and Thomas Lam and Steven Maclennan and James N'dow and Marko Babjuk and Eva Comperat and Richard Zigeuner and Sylvester, {Richard J} and Maximilian Burger and Hugh Mostafid and {van Rhijn}, {Bas W G} and Paolo Gontero and Joan Palou and Shariat, {Sharokh F} and Morgan Roupret",
note = "Copyright {\circledC} 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
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doi = "10.1016/j.euf.2017.10.003",
language = "English",
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TY - JOUR

T1 - Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

T2 - An European Association of Urology Guidelines Systematic Review

AU - Peyronnet, Benoit

AU - Seisen, Thomas

AU - Dominguez-Escrig, Jose-Luis

AU - Bruins, Harman Max

AU - Yuan, Cathy Yuhong

AU - Lam, Thomas

AU - Maclennan, Steven

AU - N'dow, James

AU - Babjuk, Marko

AU - Comperat, Eva

AU - Zigeuner, Richard

AU - Sylvester, Richard J

AU - Burger, Maximilian

AU - Mostafid, Hugh

AU - van Rhijn, Bas W G

AU - Gontero, Paolo

AU - Palou, Joan

AU - Shariat, Sharokh F

AU - Roupret, Morgan

N1 - Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2019/3

Y1 - 2019/3

N2 - CONTEXT: Most series have suggested better perioperative outcomes of laparoscopic radical nephroureterectomy (RNU) over open RNU. However, the oncological safety of laparoscopic RNU remains controversial.OBJECTIVE: To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU.EVIDENCE ACQUISITION: A systematic literature search using the Medline, Embase, and Cochrane databases and clinicaltrial.gov was performed in December 2014 and updated in August 2016. Randomised controlled trials (RCTs) and prospective or retrospective nonrandomised comparative studies comparing the oncological outcomes of any laparoscopic RNU with those of open RNU were included. The primary outcome was cancer-specific survival. The risk of bias (RoB) was assessed using Cochrane RoB tools. A narrative synthesis of the evidence is presented.EVIDENCE SYNTHESIS: Overall, 42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. Most included studies were retrospective comparative series. Only one RCT was found. RoB and confounding were high in most studies. No study compared the oncological outcomes of robotic RNU with those of open RNU. Bladder cuff excision in laparoscopic groups was performed via an open approach in most studies, with only three studies reporting laparoscopic removal of the bladder cuff. Port-site metastasis rates ranged from 0% to 2.8%. No significant difference in oncological outcomes was reported in most series. However, three studies, including the only RCT, reported significantly poorer oncological outcomes in patients who underwent laparoscopic RNU, especially in the subgroups of patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinoma (UTUC), as well as in instances when the bladder cuff was excised laparoscopically.CONCLUSIONS: The current available evidence suggests that the oncological outcomes of laparoscopic RNU may be poorer than those of open RNU when bladder cuff is excised laparoscopically and in patients with locally advanced high-risk (pT3/pT4 and/or high-grade) UTUC.PATIENT SUMMARY: We reviewed the literature comparing the outcomes of two different surgical procedures for the treatment of upper tract urothelial carcinoma. Open radical nephroureterectomy is a surgical procedure in which the kidney is removed through a large incision in the abdomen, while in laparoscopic radical nephroureterectomy, the kidney is removed through a number of small incisions. Our findings suggest that the outcomes of laparoscopic radical nephroureterectomy may be poorer than those of open radical nephroureterectomy, particularly when the bladder cuff is also required to be removed. Laparoscopic radical nephroureterectomy may also be less effective in patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinomas.

AB - CONTEXT: Most series have suggested better perioperative outcomes of laparoscopic radical nephroureterectomy (RNU) over open RNU. However, the oncological safety of laparoscopic RNU remains controversial.OBJECTIVE: To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU.EVIDENCE ACQUISITION: A systematic literature search using the Medline, Embase, and Cochrane databases and clinicaltrial.gov was performed in December 2014 and updated in August 2016. Randomised controlled trials (RCTs) and prospective or retrospective nonrandomised comparative studies comparing the oncological outcomes of any laparoscopic RNU with those of open RNU were included. The primary outcome was cancer-specific survival. The risk of bias (RoB) was assessed using Cochrane RoB tools. A narrative synthesis of the evidence is presented.EVIDENCE SYNTHESIS: Overall, 42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. Most included studies were retrospective comparative series. Only one RCT was found. RoB and confounding were high in most studies. No study compared the oncological outcomes of robotic RNU with those of open RNU. Bladder cuff excision in laparoscopic groups was performed via an open approach in most studies, with only three studies reporting laparoscopic removal of the bladder cuff. Port-site metastasis rates ranged from 0% to 2.8%. No significant difference in oncological outcomes was reported in most series. However, three studies, including the only RCT, reported significantly poorer oncological outcomes in patients who underwent laparoscopic RNU, especially in the subgroups of patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinoma (UTUC), as well as in instances when the bladder cuff was excised laparoscopically.CONCLUSIONS: The current available evidence suggests that the oncological outcomes of laparoscopic RNU may be poorer than those of open RNU when bladder cuff is excised laparoscopically and in patients with locally advanced high-risk (pT3/pT4 and/or high-grade) UTUC.PATIENT SUMMARY: We reviewed the literature comparing the outcomes of two different surgical procedures for the treatment of upper tract urothelial carcinoma. Open radical nephroureterectomy is a surgical procedure in which the kidney is removed through a large incision in the abdomen, while in laparoscopic radical nephroureterectomy, the kidney is removed through a number of small incisions. Our findings suggest that the outcomes of laparoscopic radical nephroureterectomy may be poorer than those of open radical nephroureterectomy, particularly when the bladder cuff is also required to be removed. Laparoscopic radical nephroureterectomy may also be less effective in patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinomas.

KW - Recurrence

KW - Survival

KW - Ureter

KW - Ureteral Neoplasms

KW - Upper tract

KW - Urothelial carcinoma

KW - Laparoscopy

KW - Ureteral neoplasms

KW - MANAGEMENT

KW - UPPER URINARY-TRACT

KW - INTRAVESICAL RECURRENCE

KW - FOLLOW-UP

KW - CANCER

KW - ASSISTED RETROPERITONEOSCOPIC NEPHROURETERECTOMY

KW - BLADDER-CUFF RESECTION

KW - PERIOPERATIVE OUTCOMES

KW - OPEN SURGERY

KW - TRANSITIONAL-CELL CARCINOMA

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U2 - 10.1016/j.euf.2017.10.003

DO - 10.1016/j.euf.2017.10.003

M3 - Review article

VL - 5

SP - 205

EP - 223

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

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