Safety and efficacy analysis of robotic laparoscopy and conventional laparoscopy in the treatment of non-metastatic upper tract urothelial carcinoma
Objective To compare the clinical efficacy of robot-assisted radical nephroureterectomy(RANU)and conventional laparoscopic radical nephroureterectomy(LRNU)for the treatment of non-metastatic upper urinary tract uroepithelial cancer(UTUC).Methods The clinical data of 73 patients with non-metastatic UTUC admitted to the First Hospital of Jilin University from July 2018 to December 2021 were retrospectively analyzed.In the RANU group,after completing the resection of the kidney and upper ureter under robotic-assisted laparoscopy,the resection of the lower ureter and part of the bladder wall was accomplished without changing the patients position,and the position of the robotic arm was adjusted.In the LRNU group,after laparoscopically resecting the kidney and the ureteral nephron,the resection of the lower ureter and part of the bladder wall was done in the supine position.There were 27 cases in the RANU group,including 15 males and 12 females;age(64.4±10.8)years old;body mass index(BMI)(24.4±3.4)kg/m2;16 renal pelvic tumors,9 ureteral tumors,and 2 tumors of the renal pelvis and ureters;the tumors were located in the left side of the 16 cases,and the right side of the 11 cases.In the LRNU group,there were 46 cases,including 17 males and 29 females;age(67.0±9.6)years old;BMI(23.8±3.0)kg/m2;22 renal pelvic tumors,19 ureteral tumors,and 5 tumors of the renal pelvis and ureter;the tumors were located on the left side in 30 cases,and on the right side in 16 cases.There was no statistically significant difference between the general characteristics of the two groups(P>0.05).The differences in operation time,intraoperative blood transfusion rate,pelvic and renal fossa drainage time,postoperative hospital stay,number of dissected lymph node,and postoperative complications were compared between the two groups.Results Surgery was successfully completed in both groups without transfering to open surgery.The operative time was 185(176,208)min and 132(115,153)min in the RANU group and the LRNU group,respectively(P<0.01);there were three cases of intraoperative blood transfusion in the RANU group,and no transfusion in the LRNU group(P=0.047).The number of dissected lymph node was 5.0(2.0,10.0)in the RANU group and 0.5(0,4.0)in the LRNU group,and the difference was statistically significant(P<0.05).The postoperative hospital stay in the RANU group and the LRNU group was 5(4,6)d and 5(5,6)d,the pelvic drainage time was 5(3,5)d and 4(3,4)d,the renal fossa drainage time was 4(3,5)d and 4(3,5)d,lymph node positivity rate was 2(7.4%)and 5(10.9%),and short-term postoperative(hospital stay)complications were 5(18.5%)and 2(4.4%),respectively,and there was no statistically significant difference in above-mentioned parameters between the two groups(P>0.05).The median follow-up time was 14(11,19)months in the RANU group and 31(25,40)months in the LRNU group.The bladder recurrence-free survival rate was 92.6%and 91.3%in the RANU group and the LRNU group,the overall survival rate was 96.3%and 89.1%,and the disease-free survival rate was 88.9%and 87.0%,respectively,and the difference was statistically insignificant(P>0.05).Conclusions RANU is a safe and effective surgical procedure for the treatment of non-metastatic UTUC,which can achieve similar tumor control as traditional laparoscopic surgery,and RANU has advantages in the number of lymph node dissection.
Robotic surgeryUpper urinary tract uroepithelial cancerNephroureterectomyComparative study of efficacy