Robot-Assisted Versus Open Bladder Cuff Excision After Radical Nephroureterectomy: A Multicenter Study by the French...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Upper tract urothelial carcinoma (UTUC) requires radical nephroureterectomy (RNU) with bladder cuff excision.
• Comparing robot-assisted bladder cuff excision (RA-BCE) with open bladder cuff excision (O-BCE) is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate and compare the oncological and perioperative results of RA-BCE versus O-BCE following RNU for UTUC.
• To determine the safety and efficacy of minimally invasive robotic techniques in UTUC management.

Main Methods:

• A multicenter study included 487 patients undergoing RA-BCE or O-BCE between 2014 and 2023.
• Kaplan-Meier analysis and Cox regression models assessed survival outcomes and predictors.
• Perioperative complications and length of stay were compared between the two surgical approaches.

Main Results:

• RA-BCE (n=182) and O-BCE (n=305) showed similar 3-year intravesical recurrence-free survival, extravesical recurrence-free survival, cancer-specific survival, and overall survival.
• Multivariable analysis confirmed no significant difference in recurrence or survival rates between RA-BCE and O-BCE.
• RA-BCE was associated with significantly lower overall and major 90-day complications and a shorter hospital stay.

Conclusions:

• Robot-assisted bladder cuff excision (RA-BCE) is an effective treatment for UTUC, providing oncological outcomes comparable to open bladder cuff excision (O-BCE).
• RA-BCE offers potential benefits in terms of reduced perioperative complications and shorter hospital stays, supporting its use in managing UTUC.