Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: A retrospective multicenter comparative analysis (ROBUUST collaborative analysis)
Recommended Citation
Ditonno F, Franco A, Wu Z, Wang L, Correa A, Margulis V, Djaladat H, Veccia A, Simone G, Tuderti G, Derweesh IH, Abdollah F, Singla N, Ferro M, Porpiglia F, Checcucci E, Amparore D, Gonzalgo ML, Perdonà S, Tufano A, Mehrazin R, Sundaram CP, Antonelli A, Autorino R. Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: A retrospective multicenter comparative analysis (ROBUUST collaborative analysis). Eur Urol 2024; 85:S817-S818.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: The role of kidney-sparing surgery (KSS) in patients with high-risk upper urinary tract urothelial carcinoma (UTUC) is controversial. The aim of this study was to assess the outcomes of distal ureterectomy in patients with high-risk distal ureteral tumors. Materials & Methods: The ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. After identifying high-risk patients with tumors of the distal ureter, the study population was divided into two subgroups according to surgical procedure, robot-assisted distal ureterectomy (RADU) or robot-assisted nephroureterectomy (RANU). A survival analysis of the primary endpoint recurrence-free survival (RFS), defined as the time elapsed between diagnosis and disease recurrence, was performed. Secondary endpoints were metastasis-free survival (MFS), as the time between diagnosis and metastasis onset, and overall survival (OS), as the time between diagnosis and death by any cause. 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 with distal ureteral high-risk UTUC were retrieved, of which 58 received RADU and 419 RANU, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). No significant difference in terms of baseline features was observed between the two treatment groups, including preoperative serum creatinine (SCr) (p=0.6) and estimated glomerular filtration rate (eGFR) (p=0.1). Mean (±SD) tumor size was significantly higher in the RANU group (2.9 ±2 vs 2.3 ±1.6, p=0.03), even though no difference was observed in the proportion of lesions of ≥2 cm (66.1% vs 58.5%, p=0.3). Likewise, a comparable number of patients had cT≥2 (12.4% vs 8.6%, p=0.4) tumors. At survival analysis a RFS of 8.2 months (±2.6) and 9.3 months (±4) was observed for RADU and RANU, respectively, with no significant difference between the treatment modalities (p=0.6). The two cohorts were comparable also in terms of MFS (p=0.5) and OS (p=0.7). At Cox regression analysis, in each model for the different time-to-event outcomes, the type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing RADU had significantly better post-operative renal function in terms of mean (±SD) eGFR (60.7 ±2.4 vs 52.3 ±4.9, p=0.01). Conclusions: Within the limitations related to the retrospective study design, our findings suggest comparable outcomes in terms of RFS, MFS and OS between RADU and RANU patients, and an advantage of in terms of post-operative renal function preservation. KSS might be considered as a potential option for selected high-risk patients.
Volume
85
First Page
S817
Last Page
S818
