Long-Term Oncologic Outcomes After Laparoscopic Radical Nephroureterectomy: A Contemporary Analysis From a Japanese...

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Upper tract urothelial carcinoma (UTUC) management often involves radical nephroureterectomy (RNU).
• Laparoscopic radical nephroureterectomy (LRNU) is a minimally invasive alternative to open surgery.
• Long-term oncologic outcomes and recurrence patterns after LRNU require comprehensive evaluation.

Purpose of the Study:

• To assess the long-term oncologic outcomes following laparoscopic radical nephroureterectomy (LRNU).
• To analyze recurrence patterns, with a specific focus on disseminated recurrence, after LRNU.
• To compare LRNU outcomes with historical data from open surgery for UTUC.

Main Methods:

• Retrospective analysis of 1102 patients who underwent LRNU before 2020 across nine Japanese institutions.
• Estimation of nonurothelial recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) using Kaplan-Meier analysis.
• Identification of prognostic factors for survival outcomes via Cox proportional hazard models; assessment of initial recurrence sites.

Main Results:

• Five-year RFS, CSS, and OS rates varied significantly with pathological tumor stage (pT), ranging from 92% RFS for pT<1 to 20% for pT4.
• Advanced pathological features (higher pT, positive lymph nodes) and older age were independent predictors of poorer survival outcomes.
• Distant recurrence occurred in 18% of patients, local recurrence in 11%, and urothelial recurrence in 45%; disseminated recurrence was rare (2%), with minimal port-site recurrence (0.3%).

Conclusions:

• LRNU provides favorable long-term oncologic control for UTUC.
• The rate of disseminated recurrence after LRNU is low.
• LRNU outcomes appear comparable to historical results of open radical nephroureterectomy.