Introduction

In recent years several teams have reported their techniques of robot-assisted radical nephroureterectomy (RARNU) whose main benefit is to facilitate the laparoscopic resection of the bladder cuff, which was usually performed through a Gibson incision in case of laparoscopic radical nephroureterectomy (LRNU). The objective of this study was to compare the oncological outcomes and and patterns of recurrence after RARNU vs. open RNU (ORNU) vs. LRNU.

Methods

All patients who underwent a RNU in four centers between 2008 and 2016 were included in a retrospective study. The patients were divided into three groups: RARNU, ORNU, and LRNU. The recurrence-free survival (RFS), cancer-specific (CSS), overall survival (OS) and bladder-recurrence-free survival (BRFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. The prognostic factors associated with RFS, BRFS, OS and CSS were assessed using a multivariate Cox regression model. The chi2 test was used to compare recurrence sites between the three groups.

Results

In total, 185 patients were included : 50 in the ORNU group, 93 in the LRNU group and 42 in the RARNU group. After a median follow up of 22 months, there were 34 recurrences (18.4%) with similar rates of peritoneal carcinomatosis in the three groups (15.8% vs. 12.5% vs. 14.3%; p=0.98). OS and CSS were similar in the three groups. However RFS was poorer in the robotic group compared to the open and laparoscopic groups (1 year: 57.7% vs. 76.1% vs. 76.7%; p = 0.02) as well as BRFS (1 year: 57.1% vs. 81.6% vs. 74.8%; p = 0.04). In multivariate analysis, the robotic approach was associated with BRFS (OR = 8.7; p = 0.01) but not with RFS (OR = 1.7; p = 0.92).

Conclusions

In this multicenter study, robot-assisted radical nephroureterectomy was associated with poorer RFS and BRFS than laparoscopic and open radical nephroureterectomy. In multivariate analysis, the robotic approach was associated with poorer BRFS but not RFS. Further studies with long-term follow-up are needed to confirm these findings.

Funding

none