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Comparative Study
. 2025 Jul 23;43(1):452.
doi: 10.1007/s00345-025-05815-x.

Oncological outcomes of open versus minimally invasive nephroureterectomy for locally advanced upper tract urothelial carcinoma

Luca Afferi  1   2   3 , Benjamin Pradere  4 , Andrea Gallioli  5 , Marco Moschini  6 , Donato Cannoletta  6 , Francesco Soria  7 , Tristan Juvet  8 , Aaron Potretzke  9 , Hooman Djaladat  10 , Eiji Kikuchi  11 , Andrea Mari  12 , Zineddine Khene  13 , Kazutoshi Fujita  14 , Jay D Raman  15 , John P Sfakianos  16 , John L Pfail  16 , Giovanni E Cacciamani  17 , Thomas van Doeveren  18 , Joost L Boormans  18 , Alessandro Antonelli  19 , Marcus Jamil  20 , Firas Abdollah  20 , Guillaume Ploussard  4 , Axel Heidenreich  21 , Constantin Rieger  21 , Siamak Daneshmand  10 , Stephen A Boorjian  9 , Andreas Sauer  22 , Stephen Wyler  22 , Agostino Mattei  23 , Morgan Rouprêt  24 , Michael Rink  25 , Shahrokh F Shariat  26   27   28   29   30 , Alberto Breda #  5 , Nico C Grossmann #  23
Affiliations
Comparative Study

Oncological outcomes of open versus minimally invasive nephroureterectomy for locally advanced upper tract urothelial carcinoma

Luca Afferi et al. World J Urol. .

Abstract

Introduction & objectives: It is currently recommended to perform open radical nephroureterectomy (oRNU) with bladder cuff excision in patients with locally advanced (cT3-4 or cN1-2) upper tract urothelial carcinoma (laUTUC). We tested the hypothesis that bladder recurrence-free survival (BRFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) are not influenced by the surgical approach in patients with laUTUC using a large multicenter series.

Material & methods: This was a multicenter retrospective cohort study including 361 patients with preoperative cT3-4 cM0 or cN1-2 cM0 laUTUC treated with open or minimally invasive RNU from 1999 to 2019 at 21 academic centers in Europe, Asia, and the United States. Missing values of relevant baseline characteristics were estimated through multiple imputation of chained equations. Baseline patients' heterogeneity was balanced using a 1:1 propensity score matching estimated using logistic regression. Uni- and multivariable Cox regression analyses for bladder recurrence, metastasis, cancer-specific death and overall death were performed according to clinical and pathological characteristics. Kaplan Meier (KM) estimates and log-rank test were used to compare BRFS, MFS, CSS and OS according to clinical and pathological features.

Results: Median follow-up was 28 months. After propensity score matching, two cohorts of 115 laUTUC patients each with similar baseline and preoperative tumor characteristics were obtained. In the matched cohort, pT ≥ 3 stage was found in 84 (73%) and 67 (58.3%) patients in the oRNU and miRNU groups, respectively. Positive lymph nodes were detected in 27 (23.5%) and 32 (27.8%) patients in the oRNU and miRNU groups, respectively. In the multivariable regression analysis, pT ≥ 3 and positive lymph nodes were associated with an increased risk of metastasis (HR 3.22, 95% CI 1.26-8.23, and HR 4.03, 95% CI 2.05-7.89, respectively). The surgical approach (oRNU vs. mi RNU) did not influence oncological outcomes as shown by uni- and multivariable analyses as well as Kaplan-Meier estimates, regardless of pT stage.

Conclusions: The oncological outcomes of laUTUC for cT3-4 cM0 or cN1-2 cM0 disease are comparable whether RNU is performed via an open or minimally invasive approach. Therefore, the decision to opt for oRNU or miRNU should be guided by the surgeon's expertise and the patient's comorbidities, rather than concerns over long-term oncological outcomes associated with either surgical technique.

Keywords: Locally advanced Utuc; Minimally-invasive nephroureterectomy; Open nephroureterectomy; Upper tract urothelial cancer; Utuc.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Research involving human and/or animal: This article does not contain any studies/experiments with human participants or animals performed by any of the authors. Informed consent: All persons gave their informed consent to use their data (deidentified).

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