Frontiers in Oncology (Oct 2021)
Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma
- Ching-Chia Li,
- Ching-Chia Li,
- Ching-Chia Li,
- Chao-Hsiang Chang,
- Chao-Hsiang Chang,
- Chi-Ping Huang,
- Chi-Ping Huang,
- Jian-Hua Hong,
- Jian-Hua Hong,
- Chao-Yuan Huang,
- I-Hsuan Alan Chen,
- Jen-Tai Lin,
- Chi-Wen Lo,
- Chih-Chin Yu,
- Chih-Chin Yu,
- Jen-Shu Tseng,
- Jen-Shu Tseng,
- Jen-Shu Tseng,
- Wun-Rong Lin,
- Wun-Rong Lin,
- Wei-Che Wu,
- Wei-Che Wu,
- Shiu-Dong Chung,
- Shiu-Dong Chung,
- Thomas Y. Hsueh,
- Thomas Y. Hsueh,
- Allen W. Chiu,
- Yung-Tai Chen,
- Shin-Hong Chen,
- Yuan-Hong Jiang,
- Yao-Chou Tsai,
- Yao-Chou Tsai,
- Bing-Juin Chiang,
- Bing-Juin Chiang,
- Bing-Juin Chiang,
- Wei Yu Lin,
- Wei Yu Lin,
- Wei Yu Lin,
- Yeong-Chin Jou,
- Yeong-Chin Jou,
- Chia-Chang Wu,
- Chia-Chang Wu,
- Chia-Chang Wu,
- Hsiang-Ying Lee,
- Hsiang-Ying Lee,
- Hsiang-Ying Lee,
- Hsiang-Ying Lee,
- Hsin-Chih Yeh,
- Hsin-Chih Yeh,
- Hsin-Chih Yeh,
- Hsin-Chih Yeh
Affiliations
- Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Ching-Chia Li
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ching-Chia Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Chao-Hsiang Chang
- School of Medicine, China Medical University, Taichung, Taiwan
- Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Chi-Ping Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Chih-Chin Yu
- 0School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- Jen-Shu Tseng
- 1Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Jen-Shu Tseng
- 2Department of Urology, Mackay Medical College, New Taipei City, Taiwan
- Jen-Shu Tseng
- 3Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Wun-Rong Lin
- 1Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Wun-Rong Lin
- 2Department of Urology, Mackay Medical College, New Taipei City, Taiwan
- Wei-Che Wu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Wei-Che Wu
- 4Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Shiu-Dong Chung
- 4Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Shiu-Dong Chung
- 5Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
- Thomas Y. Hsueh
- 6Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan
- Thomas Y. Hsueh
- 7Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Allen W. Chiu
- 8College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Yung-Tai Chen
- 9Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
- Shin-Hong Chen
- 9Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
- Yuan-Hong Jiang
- 0Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Yao-Chou Tsai
- 1Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Yao-Chou Tsai
- 2Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Bing-Juin Chiang
- 3College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Bing-Juin Chiang
- 4Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Bing-Juin Chiang
- 5Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Wei Yu Lin
- 6Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Wei Yu Lin
- 7Chang Gung University of Science and Technology, Chiayi, Taiwan
- Wei Yu Lin
- 8Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Yeong-Chin Jou
- 9Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Yeong-Chin Jou
- 0Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
- Chia-Chang Wu
- 1Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Chia-Chang Wu
- 1Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Chia-Chang Wu
- 2TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- 3Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Hsiang-Ying Lee
- 4Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- 3Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- DOI
- https://doi.org/10.3389/fonc.2021.731460
- Journal volume & issue
-
Vol. 11
Abstract
PurposeThis study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy.MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches.ResultsAmong the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001).ConclusionsMinimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.
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