Outcomes of laparoscopic, robotic and open nephroureterectomy with bladder cuff excision in patients with T3T4 upper urinary tract urothelial carcinoma: a multi-center retrospective study

Abstract Background Nephroureterectomy with bladder cuff excision is the standard treatment for high-risk upper urinary tract urothelial carcinoma (UTUC). Minimally invasive surgery is the most common procedure in our experience, however previous prospective studies have reported inferior oncological outcomes of laparoscopic nephroureterectomy for locally advanced UTUC. The aim of this study was to compare the outcomes of open, laparoscopic and robotic surgery. Methods We retrospectively reviewed 705 patients with locally advanced UTUC from multiple institutions throughout Taiwan. Perioperative outcomes and oncological outcomes were compared between the open, laparoscopic and robotic groups. Results The minimally invasive group had better overall and cancer-specific survival (CSS) rates. The 5-year CSS rates of the open, laparoscopic and robotic groups were 51%, 69%, and 77% respectively (p < 0.001). The robotic group had similar outcomes to the laparoscopic group. More lymph node dissections were performed and more lymph nodes were harvested in the robotic group. Conclusions Laparoscopic or robotic surgery can lead to better perioperative and oncological results in patients with locally advanced UTUC.