Long-Term Oncologic Outcomes After Laparoscopic Radical Nephroureterectomy: A Contemporary Analysis From a Japanese
Toru Kanno1, Ryoichi Saito2, Yuki Kita3
1Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Objectives:
To evaluate long-term oncologic outcomes and recurrence patterns after laparoscopic radical nephroureterectomy (LRNU) performed more than five years earlier.
Patients And Methods:
We retrospectively analyzed patients who underwent LRNU before 2020 at nine Japanese institutions. Nonurothelial recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazard models were applied to identify prognostic factors. Initial recurrence sites were assessed, with particular focus on disseminated recurrence.
Results:
A total of 1102 patients were included, with a median follow-up of 57 months. Clinically locally advanced disease was observed in 212 patients (19%), including 178 (16%) with cT3-4 tumors and 64 (6%) with cN-positive disease. Lymphadenectomy was performed in 557 cases (51%). The 5-year RFS rates for pT < 1, pT1, pT2, pT3, and pT4 were 92%, 87%, 70%, 48%, and 20%, respectively. The corresponding CSS rates were 96%, 94%, 81%, 61%, and 21%, and the corresponding OS rates were 84%, 78%, 71%, 53%, and 15%. Older age at surgery and advanced pathological features were independent predictors of poorer RFS, CSS, and OS. Regarding recurrence patterns, distant recurrence occurred in 203 patients (18%), local recurrence in 127 (11%), and urothelial recurrence in 489 (45%). Disseminated recurrence was rare, occurring in 25 patients (2%), including 18 with retroperitoneal carcinomatosis and 3 (0.3%) with port-site recurrence.
Conclusions:
Our findings suggest that LRNU provides favorable long-term oncologic outcomes with low disseminated recurrence rates, appearing comparable to historical outcomes of open surgery.