Alessandro Veccia1, Umberto Carbonara1, Hooman Djaladat2, Reza Mehazin3, Daniel D Eun4, Adam C Reese4, Xiaosong Meng5, Robert Uzzo6, Abhishek Srivastava6, James Porter7, Jason M Farrow8, Marcus L Jamil9, Giuseppe Rosiello10,11, Riccardo Tellini12, Andrea Mari12, Ali Al-Qathani13, Koon H Rha13, Linhui Wang14, Riccardo Mastroianni15, Matteo Ferro16, Ottavio De Cobelli16, Kevin Hakimi17, Fabio Crocerossa1, Alireza Ghoreifi2, Giovanni Cacciamani2, Amit S Bhattu18, Alexandre Mottrie10, Firas Abdollah9, Andrea Minervini12, Zhenjie Wu14, Giuseppe Simone15, Ithaar Derweesh17, Mark L Gonzalgo18, Vitaly Margulis5, Chandru P Sundaram8, Riccardo Autorino1. 1. Division of Urology and Massey Cancer Center, VCU Health System, Richmond, Virginia, USA. 2. Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. 3. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 6. Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. 7. Swedish Urology Group, Seattle, Washington, USA. 8. Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA. 9. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA. 10. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 11. ORSI Academy, Melle, Belgium. 12. Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy. 13. Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. 14. Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China. 15. Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy. 16. Division of Urology, IRCCS European Institute of Oncology, Milan, Italy. 17. Department of Urology, UCSD School of Medicine, La Jolla, California, USA. 18. Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Abstract
Purpose: To compare the outcomes of robotic radical nephroureterectomy (RRNU) and laparoscopic radical nephroureterectomy (LRNU) within a large multi-institutional worldwide dataset. Materials and Methods: The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) includes data from 17 centers worldwide regarding 877 RRNU and LRNU performed between 2015 and 2019. Baseline features, perioperative and oncologic outcomes, were included. A 2:1 nearest-neighbor propensity-score matching with a 0.001 caliper was performed. A univariable and a multivariable logistic regression model were built to evaluate the predictors of a composite "tetrafecta" outcome defined as occurrence of bladder cuff excision+LND+no complications+negative surgical margins. Results: After matching, 185 RRNU and 91 LRNU were assessed. Patients in the RRNU group were more likely to undergo bladder cuff excision (81.9% vs 63.7%; p < 0.001) compared to the LRNU group. A statistically significant difference was found in terms of overall postoperative complications (p = 0.003) and length of stay (p < 0.001) in favor of RRNU. Multivariable analysis demonstrated that LRNU was an independent predictor negatively associated with achievement of "tetrafecta" (odds ratio: 0.09; p = 0.003). Conclusions: In general, RRNU and LRNU offer comparable outcomes. While the rate of overall complications is higher for LRNU in this study population, this is mostly related to low-grade complications, and therefore with more limited clinical relevance. RRNU seems to offer shorter hospital stay, but this might also be related to the different geographical location of participating centers. Overall, the implementation of robotics might facilitate achievement of a "tetrafecta" outcome as defined in the present study.
Purpose: To compare the outcomes of robotic radical nephroureterectomy (RRNU) and laparoscopic radical nephroureterectomy (LRNU) within a large multi-institutional worldwide dataset. Materials and Methods: The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) includes data from 17 centers worldwide regarding 877 RRNU and LRNU performed between 2015 and 2019. Baseline features, perioperative and oncologic outcomes, were included. A 2:1 nearest-neighbor propensity-score matching with a 0.001 caliper was performed. A univariable and a multivariable logistic regression model were built to evaluate the predictors of a composite "tetrafecta" outcome defined as occurrence of bladder cuff excision+LND+no complications+negative surgical margins. Results: After matching, 185 RRNU and 91 LRNU were assessed. Patients in the RRNU group were more likely to undergo bladder cuff excision (81.9% vs 63.7%; p < 0.001) compared to the LRNU group. A statistically significant difference was found in terms of overall postoperative complications (p = 0.003) and length of stay (p < 0.001) in favor of RRNU. Multivariable analysis demonstrated that LRNU was an independent predictor negatively associated with achievement of "tetrafecta" (odds ratio: 0.09; p = 0.003). Conclusions: In general, RRNU and LRNU offer comparable outcomes. While the rate of overall complications is higher for LRNU in this study population, this is mostly related to low-grade complications, and therefore with more limited clinical relevance. RRNU seems to offer shorter hospital stay, but this might also be related to the different geographical location of participating centers. Overall, the implementation of robotics might facilitate achievement of a "tetrafecta" outcome as defined in the present study.