Julian Hanske1,2, Alejandro Sanchez3, Marianne Schmid1,4, Christian P Meyer1,4, Firas Abdollah5, Adam S Feldman3, Adam S Kibel1, Jesse D Sammon5, Mani Menon5, Jairam R Eswara1, Joachim Noldus2, Quoc-Dien Trinh1. 1. 1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts. 2. 2 Department of Urology, Marien Hospital, Ruhr-University Bochum , Herne, Germany . 3. 3 Department of Urology, Massachusetts General Hospital , Boston, Massachusetts. 4. 4 Department of Urology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany . 5. 5 Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute , Henry Ford Health System, Detroit, Michigan.
Abstract
BACKGROUND AND PURPOSE: Minimally invasive surgery for nephroureterectomy (MINU) in patients with upper tract urothelial carcinoma (UTUC) is increasingly used among urologists with reported equivalent oncologic outcomes compared with open nephroureterectomy (ONU). Population-level data comparing perioperative outcomes between these approaches remain limited, however. We sought to compare perioperative outcomes between MINU and ONU in a prospectively collected national cohort of patients. METHODS: Between 2006 and 2012, patients who underwent nephroureterectomy for UTUC within the American College of Surgeons-National Surgical Quality Improvement Program database were categorized into MINU or ONU. Our primary outcome of interest was 30-day perioperative complications. Secondary outcomes included use of lymph node dissection (LND), transfusion, reintervention and readmission rate, operative time, length of stay (LOS), and perioperative mortality. Multivariable logistic regression analyses were used to examine the association between outcomes and surgical approach. RESULTS: A total of 599 (66.9%) and 297 (33.1%) patients underwent MINU and ONU, respectively. Overall, 12.7% of patients experienced a complication within 30 days postoperatively, and the rate did not differ among surgical approaches. Patients in the MINU group, however, had a decreased LOS (P<0.001). On multivariable analysis, patients receiving MINU were less likely to undergo a LND (OR 0.13; P<0.001), had decreased risk of thromboembolic complications (odds ratio [OR] 0.13; P=0.018), decreased need for transfusion (OR 0.39; P=0.001), and decreased need for operative reintervention (OR 0.24; P=0.024). CONCLUSIONS: Patients receiving MINU have similar overall complication rates compared with ONU. MINU, however, was associated with a decreased risk of blood transfusions, thromboembolic events, reintervention, and overall LOS compared with ONU. MINU should be considered as a primary approach in select groups of patients with UTUC.
BACKGROUND AND PURPOSE: Minimally invasive surgery for nephroureterectomy (MINU) in patients with upper tract urothelial carcinoma (UTUC) is increasingly used among urologists with reported equivalent oncologic outcomes compared with open nephroureterectomy (ONU). Population-level data comparing perioperative outcomes between these approaches remain limited, however. We sought to compare perioperative outcomes between MINU and ONU in a prospectively collected national cohort of patients. METHODS: Between 2006 and 2012, patients who underwent nephroureterectomy for UTUC within the American College of Surgeons-National Surgical Quality Improvement Program database were categorized into MINU or ONU. Our primary outcome of interest was 30-day perioperative complications. Secondary outcomes included use of lymph node dissection (LND), transfusion, reintervention and readmission rate, operative time, length of stay (LOS), and perioperative mortality. Multivariable logistic regression analyses were used to examine the association between outcomes and surgical approach. RESULTS: A total of 599 (66.9%) and 297 (33.1%) patients underwent MINU and ONU, respectively. Overall, 12.7% of patients experienced a complication within 30 days postoperatively, and the rate did not differ among surgical approaches. Patients in the MINU group, however, had a decreased LOS (P<0.001). On multivariable analysis, patients receiving MINU were less likely to undergo a LND (OR 0.13; P<0.001), had decreased risk of thromboembolic complications (odds ratio [OR] 0.13; P=0.018), decreased need for transfusion (OR 0.39; P=0.001), and decreased need for operative reintervention (OR 0.24; P=0.024). CONCLUSIONS:Patients receiving MINU have similar overall complication rates compared with ONU. MINU, however, was associated with a decreased risk of blood transfusions, thromboembolic events, reintervention, and overall LOS compared with ONU. MINU should be considered as a primary approach in select groups of patients with UTUC.
Authors: Scott Geiger; Neil Kocher; Dan Illinsky; Evanguelos Xylinas; Peter Chang; Lauren Dewey; Andrew A Wagner; Firas Petros; Surena F Matin; Conrad Tobert; Chad Tracy; Pierre-Marie Patard; Mathieu Roumiguie; Leonardo Lima Monteiro; Wassim Kassouf; Jay D Raman Journal: Transl Androl Urol Date: 2020-08