BACKGROUND: The role of kidney -sparing surgery in patients with high -risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot -assisted distal ureterectomy in patients with high -risk distal ureteral tumors. METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High -risk patients with distal ureteral tumors were divided based on type of surgery: robot -assisted distal ureterectomy or robot -assisted nephroureterectomy. A survival analysis was performed for local recurrence -free survival, distant metastasis -free survival, and overall survival. After adjusting for clinical features of the high -risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time -to -event outcomes. RESULTS: Overall, 477 patients were retrieved, of which 58 received robot -assisted distal ureterectomy and 419 robot assisted nephroureterectomy, respectively, with a mean (+/- SD) follow-up of 29.6 months (+/- 2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence -free survival (P=0.6), metastasis -free survival (P=0.5) and overall survival (P=0.7) between robot -assisted distal ureterectomy and robot -assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot -assisted distal ureterectomy had significantly better postoperative renal function. CONCLUSIONS: Comparable outcomes in terms of recurrence -free survival, metastasis -free survival, and overall survival between robot -assisted distal ureterectomy and robot -assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney -sparing surgery should be considered as a potential option for selected patients with high -risk distal ureteral UTUC.
Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group)
Ditonno, Francesco;Franco, Antonio;Antonelli, Alessandro;
2024-01-01
Abstract
BACKGROUND: The role of kidney -sparing surgery in patients with high -risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot -assisted distal ureterectomy in patients with high -risk distal ureteral tumors. METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High -risk patients with distal ureteral tumors were divided based on type of surgery: robot -assisted distal ureterectomy or robot -assisted nephroureterectomy. A survival analysis was performed for local recurrence -free survival, distant metastasis -free survival, and overall survival. After adjusting for clinical features of the high -risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time -to -event outcomes. RESULTS: Overall, 477 patients were retrieved, of which 58 received robot -assisted distal ureterectomy and 419 robot assisted nephroureterectomy, respectively, with a mean (+/- SD) follow-up of 29.6 months (+/- 2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence -free survival (P=0.6), metastasis -free survival (P=0.5) and overall survival (P=0.7) between robot -assisted distal ureterectomy and robot -assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot -assisted distal ureterectomy had significantly better postoperative renal function. CONCLUSIONS: Comparable outcomes in terms of recurrence -free survival, metastasis -free survival, and overall survival between robot -assisted distal ureterectomy and robot -assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney -sparing surgery should be considered as a potential option for selected patients with high -risk distal ureteral UTUC.
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