5a22a62ecfc9d4eee0c20c99d2fa5cbd 302841.pdf 084960732e267719e6a78b386f9446dee4022859 302841.pdf 8666944f82522fc2199e0741fa98488f7fd524a4c64ea85ce04617e2268761bb 302841.pdf Title: Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis Subject: Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990–2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien–Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan–Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22–2.28, p = 0.001 and HR 1.73, 95%CI 1.22–2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta -1.1, 95% CI -2.2–0.02, p = 0.047 and beta -6.1, 95% CI -7.2–5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31–0.79, p = 0.003 and OR 0.27, 95% CI 0.16–0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs. Keywords: RNU; UTUC; transitional cell carcinoma; treatment outcomes; surgical approach Author: Nico C. Grossmann, Francesco Soria, Tristan Juvet, Aaron M. Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximillian Pallauf, Cédric Poyet, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Guillaume Ploussard, Axel Heidenreich, Enno Storz, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat and Benjamin Pradere Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Feb 23 08:47:42 2023 CET ModDate: Thu Feb 23 09:23:10 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 22 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 934963 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JENETS+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 PGKRVH+VnURWPalladioL Type 1 Custom yes yes no 15 0 GAVAIJ+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 DGGYDP+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 NHUCFB+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 RQPVQI+CMSY10 Type 1 Builtin yes yes no 32 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 51 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 82 0 PHLLFJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 119 0 PHLLFL+PalatinoLinotype TrueType WinAnsi yes yes no 122 0 PHLLGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 125 0 PHMGOI+Calibri,Bold CID TrueType Identity-H yes yes yes 128 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-11-21 02:49:43 CET RepresentationInformation: 302841.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-11-20 13:46:00 CET Size: 934963 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 319 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Cohort Description and Patient Management Destination: subsection.2.1 Item: Title: Follow-Up and Outcome Measurement Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Study Cohort and Clinicopathologic Characteristics Destination: subsection.3.1 Item: Title: Association of the Surgical Approach with Survival Outcomes Destination: subsection.3.2 Item: Title: Association of the Surgical Approach with Perioperative Outcomes Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis Author: Nico C. Grossmann, Francesco Soria, Tristan Juvet, Aaron M. Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximillian Pallauf, Cédric Poyet, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Guillaume Ploussard, Axel Heidenreich, Enno Storz, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat and Benjamin Pradere Subject: Objectives: To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU). Methods: We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990 2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien Dindo > 3) were assessed between groups. Results: Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22 2.28, p = 0.001 and HR 1.73, 95%CI 1.22 2.47, p = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta -1.1, 95% CI -2.2 0.02, p = 0.047 and beta -6.1, 95% CI -7.2 5.0, p < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31 0.79, p = 0.003 and OR 0.27, 95% CI 0.16 0.46, p < 0.001, respectively). Conclusions: In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs. Keywords: RNU; UTUC; transitional cell carcinoma; treatment outcomes; surgical approach Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Feb 23 08:47:42 CET 2023 ModDate: Thu Feb 23 09:23:10 CET 2023 ID: 0xcfe2340987aae4d0494729288147420c, 0xcfe2340987aae4d0494729288147420c Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: RQPVQI+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: RQPVQI+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: GAVAIJ+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 150 FontDescriptor: FontName: GAVAIJ+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DGGYDP+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: DGGYDP+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JENETS+VnURWPalladioL-Bold FontSubset: true FirstChar: 178 LastChar: 182 FontDescriptor: FontName: JENETS+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: NHUCFB+URWPalladioL-Ital FontSubset: true FirstChar: 45 LastChar: 121 FontDescriptor: FontName: NHUCFB+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: PGKRVH+VnURWPalladioL FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: PGKRVH+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 82, 281, 152, 290 Annotation: Subtype: Link Rect: 34, 270, 113, 278 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 152, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 143, 604, 154, 617 Annotation: Subtype: Link Rect: 114, 591, 126, 605 Annotation: Subtype: Link Rect: 261, 591, 272, 605 Annotation: Subtype: Link Rect: 466, 591, 477, 605 Annotation: Subtype: Link Rect: 195, 579, 206, 592 Annotation: Subtype: Link Rect: 487, 579, 498, 592 Annotation: Subtype: Link Rect: 429, 566, 440, 580 Annotation: Subtype: Link Rect: 127, 554, 138, 567 Annotation: Subtype: Link Rect: 249, 554, 260, 567 Annotation: Subtype: Link Rect: 418, 554, 429, 567 Annotation: Subtype: Link Rect: 539, 554, 550, 567 Annotation: Subtype: Link Rect: 271, 529, 282, 542 Annotation: Subtype: Link Rect: 408, 529, 419, 542 Annotation: Subtype: Link Rect: 114, 17, 265, 28 Annotation: Subtype: Link Rect: 410, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 438, 87, 457 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 442, 205, 449, 214 ActionDest: 167 Annotation: Subtype: Link Rect: 549, 193, 556, 202 ActionDest: 167 Annotation: Subtype: Link Rect: 198, 155, 205, 164 ActionDest: 167 Annotation: Subtype: Link Rect: 461, 130, 468, 139 ActionDest: 167 Annotation: Subtype: Link Rect: 308, 105, 315, 114 ActionDest: 167 Annotation: Subtype: Link Rect: 318, 105, 330, 114 ActionDest: 167 Annotation: Subtype: Link Rect: 453, 105, 460, 114 ActionDest: 167 Annotation: Subtype: Link Rect: 461, 105, 473, 114 ActionDest: 167 Annotation: Subtype: Link Rect: 476, 105, 488, 114 ActionDest: 170 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 483, 558, 495, 568 ActionDest: 170 Annotation: Subtype: Link Rect: 498, 558, 510, 568 ActionDest: 170 Annotation: Subtype: Link Rect: 492, 521, 504, 530 ActionDest: 170 Annotation: Subtype: Link Rect: 511, 257, 523, 266 ActionDest: 170 Annotation: Subtype: Link Rect: 450, 106, 462, 115 ActionDest: 170 Annotation: Subtype: Link Rect: 389, 94, 401, 102 ActionDest: 170 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 544, 698, 556, 707 ActionDest: 170 Annotation: Subtype: Link Rect: 545, 647, 557, 657 ActionDest: 170 Annotation: Subtype: Link Rect: 282, 393, 289, 405 ActionDest: 98 Page: Sequence: 5 Page: Sequence: 6 Page: Sequence: 7 Page: Sequence: 8 Page: Sequence: 9 Page: Sequence: 10 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 455, 675, 462, 687 ActionDest: 101 Annotation: Subtype: Link Rect: 516, 183, 523, 194 ActionDest: 149 Page: Sequence: 12 Page: Sequence: 13 Page: Sequence: 14 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 212, 678, 219, 690 ActionDest: 158 Page: Sequence: 16 Page: Sequence: 17 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 250, 615, 257, 624 ActionDest: 167 Annotation: Subtype: Link Rect: 258, 615, 265, 624 ActionDest: 167 Annotation: Subtype: Link Rect: 265, 615, 277, 624 ActionDest: 167 Annotation: Subtype: Link Rect: 278, 615, 289, 624 ActionDest: 170 Annotation: Subtype: Link Rect: 290, 615, 302, 624 ActionDest: 170 Annotation: Subtype: Link Rect: 302, 615, 314, 624 ActionDest: 170 Annotation: Subtype: Link Rect: 317, 615, 329, 624 ActionDest: 170 Annotation: Subtype: Link Rect: 192, 577, 199, 586 ActionDest: 167 Annotation: Subtype: Link Rect: 199, 577, 211, 586 ActionDest: 167 Annotation: Subtype: Link Rect: 212, 577, 224, 586 ActionDest: 170 Annotation: Subtype: Link Rect: 227, 577, 239, 586 ActionDest: 170 Annotation: Subtype: Link Rect: 385, 552, 397, 561 ActionDest: 170 Annotation: Subtype: Link Rect: 549, 527, 556, 536 ActionDest: 167 Annotation: Subtype: Link Rect: 486, 414, 493, 423 ActionDest: 167 Annotation: Subtype: Link Rect: 494, 414, 506, 423 ActionDest: 170 Annotation: Subtype: Link Rect: 506, 414, 518, 423 ActionDest: 170 Annotation: Subtype: Link Rect: 222, 376, 229, 385 ActionDest: 167 Annotation: Subtype: Link Rect: 469, 364, 481, 373 ActionDest: 170 Annotation: Subtype: Link Rect: 303, 339, 315, 348 ActionDest: 170 Annotation: Subtype: Link Rect: 393, 314, 405, 323 ActionDest: 170 Annotation: Subtype: Link Rect: 408, 314, 420, 323 ActionDest: 170 Annotation: Subtype: Link Rect: 472, 276, 484, 285 ActionDest: 170 Annotation: Subtype: Link Rect: 484, 276, 496, 285 ActionDest: 170 Annotation: Subtype: Link Rect: 276, 251, 288, 260 ActionDest: 170 Annotation: Subtype: Link Rect: 544, 238, 556, 247 ActionDest: 170 Annotation: Subtype: Link Rect: 194, 213, 206, 222 ActionDest: 170 Annotation: Subtype: Link Rect: 307, 188, 319, 197 ActionDest: 170 Annotation: Subtype: Link Rect: 322, 188, 334, 197 ActionDest: 174 Annotation: Subtype: Link Rect: 544, 100, 556, 109 ActionDest: 174 Page: Sequence: 19 Annotations: Annotation: Subtype: Link Rect: 536, 687, 543, 696 ActionDest: 167 Annotation: Subtype: Link Rect: 544, 687, 556, 696 ActionDest: 174 Annotation: Subtype: Link Rect: 525, 246, 560, 257 Annotation: Subtype: Link Rect: 165, 234, 378, 245 Page: Sequence: 20 Annotations: Annotation: Subtype: Link Rect: 468, 496, 505, 507 Annotation: Subtype: Link Rect: 511, 496, 547, 507 Annotation: Subtype: Link Rect: 104, 462, 141, 473 Annotation: Subtype: Link Rect: 147, 462, 183, 473 Annotation: Subtype: Link Rect: 162, 428, 199, 438 Annotation: Subtype: Link Rect: 206, 428, 242, 438 Annotation: Subtype: Link Rect: 278, 393, 315, 404 Annotation: Subtype: Link Rect: 59, 359, 96, 369 Annotation: Subtype: Link Rect: 59, 324, 96, 335 Annotation: Subtype: Link Rect: 223, 290, 261, 300 Annotation: Subtype: Link Rect: 112, 255, 150, 266 Annotation: Subtype: Link Rect: 272, 220, 310, 231 Annotation: Subtype: Link Rect: 296, 185, 334, 196 Annotation: Subtype: Link Rect: 236, 152, 274, 162 Annotation: Subtype: Link Rect: 126, 117, 163, 127 Annotation: Subtype: Link Rect: 169, 117, 205, 127 Annotation: Subtype: Link Rect: 59, 83, 96, 93 Annotation: Subtype: Link Rect: 102, 83, 138, 93 Page: Sequence: 21 Annotations: Annotation: Subtype: Link Rect: 162, 724, 198, 735 Annotation: Subtype: Link Rect: 95, 678, 133, 689 Annotation: Subtype: Link Rect: 139, 678, 175, 689 Annotation: Subtype: Link Rect: 152, 644, 190, 654 Annotation: Subtype: Link Rect: 255, 608, 293, 619 Annotation: Subtype: Link Rect: 357, 574, 395, 585 Annotation: Subtype: Link Rect: 171, 540, 208, 550 Annotation: Subtype: Link Rect: 171, 506, 208, 516 Annotation: Subtype: Link Rect: 441, 482, 479, 493 Annotation: Subtype: Link Rect: 485, 482, 521, 493 Annotation: Subtype: Link Rect: 59, 448, 96, 458 Annotation: Subtype: Link Rect: 102, 448, 138, 458 Annotation: Subtype: Link Rect: 131, 425, 168, 435 Annotation: Subtype: Link Rect: 175, 425, 211, 435 Annotation: Subtype: Link Rect: 131, 402, 168, 412 Annotation: Subtype: Link Rect: 211, 378, 249, 389 Annotation: Subtype: Link Rect: 255, 378, 291, 389 Annotation: Subtype: Link Rect: 287, 355, 324, 366 Annotation: Subtype: Link Rect: 412, 275, 450, 286 Annotation: Subtype: Link Rect: 449, 240, 486, 251 Annotation: Subtype: Link Rect: 152, 207, 190, 217 Annotation: Subtype: Link Rect: 259, 171, 296, 182 Annotation: Subtype: Link Rect: 302, 171, 338, 182 Annotation: Subtype: Link Rect: 168, 103, 206, 113 Annotation: Subtype: Link Rect: 212, 103, 248, 113 Annotation: Subtype: Link Rect: 383, 68, 420, 79 Page: Sequence: 22 Annotations: Annotation: Subtype: Link Rect: 113, 713, 151, 723 Annotation: Subtype: Link Rect: 157, 713, 193, 723 Annotation: Subtype: Link Rect: 344, 678, 381, 689 Annotation: Subtype: Link Rect: 176, 644, 214, 654 Checksum: f4d14820 Type: CRC32 Checksum: 5a22a62ecfc9d4eee0c20c99d2fa5cbd Type: MD5 Checksum: 084960732e267719e6a78b386f9446dee4022859 Type: SHA-1 Checksum: 8666944f82522fc2199e0741fa98488f7fd524a4c64ea85ce04617e2268761bb Type: SHA-256