Introduction

Laparoscopic radical nephroureterectomy (LRNU) has now emerged as an alternative treatment method to open radical nephroureterectomy (ORNU). However, in terms of cancer control, there are conflicting data. In most reported studies, regional lymph node dissection (LND) was frequently skipped, which might have caused staging migration. Our group and Tokyo Women&[prime]s Medical University (TWMU) have been actively performing regional LND. Our group has preferred LRNU (J Endourol 2015) while ORNU has been preferred in TWMU (J Urol 2007). The aim of the present study was to compare survival outcomes between LRNU and ORNU in patients (pts) undergoing regional LND.

Methods

We retrospectively analyzed the data of 214 cTanyN0M0 pts undergoing radical nephroureterectomy with regional LND at 3 hospitals between 2000-15. The pts undergoing neoadjuvant chemotherapy were not included. The template of LND was previously reported. Briefly, LNs around great vessels were removed in pelvic/upper ureteral tumors and endopelvic LNs in lower ureteral tumors. In LRNU for pelvic/upper ureteral tumors, LND was also performed laparoscopically. The survival outcomes included overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method and Cox-hazard model were used for analyses.

Results

A total of 114 pts underwent LRNU and 100 received ORNU. There was no significant difference in the pT stage, pN stage, tumor grade, or LNs count removed (median: 11.5) between the two groups, but lower ureteral tumors were more frequent in the LRNU group. LN metastasis was pathologically identified in 19 pts (8.9%). The 5-year OS (75.9 vs. 72.8%, log-rank p=0.346) and CSS (80 vs. 77.8%, p=0.8441) did not differ significantly between the LRNU and ORNU groups. Multivariate analyses showed that the age, pT3/4 and pN+ were adverse prognostic factors. In the sub-analysis of pT3/4 pts (n=83), the 5-year OS (42.6 vs. 60.9%, log-rank p=0.2181) and CSS (48.4 vs. 62.4%, p=0.3763) did not differ significantly between the LRNU and ORNU groups. The multivariate model of OS revealed that the age, a lower ureteral tumor, and pN+ were independent adverse factors, while pN+ was significant and the other two were marginal in the univariate model of CSS. After adjusting for those three factors, LRNU continued to show no association with a poorer OS or CSS in pT3/4 pts.

Conclusions

Our data support the non-inferior oncological outcome of LNU compared with ORNU when regional LND is performed.

Funding

none