Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

  • Vincent Trudeau Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  • Giorgio Gandaglia 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada 2Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
  • Jonas Shiffmann 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada 3Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
  • Ioana Popa 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  • Shahrokh F Shariat 4Department of Urology, Medical University of Vienna, Vienna, Austria
  • Francesco Montorsi 2Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
  • Paul Perrotte 5Department of Urology, University of Montreal Health Centre, Montreal, Canada
  • Quoc-Dien Trinh 6Department of Surgery, Division of Urology, Brigham and Women's Hospital / Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
  • Pierre I Karakiewicz 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada 5Department of Urology, University of Montreal Health Centre, Montreal, Canada
  • Maxine Sun 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
Keywords: Robot-assisted neprhoureterectomy, laparoscopic nephroureterectomy, upper tract urothelial cancer, short-term outcomes

Abstract

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC).

Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures.

Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade.

Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.

Author Biographies

Vincent Trudeau, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
Co-First Author for this publication
Giorgio Gandaglia, 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada 2Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
Co-First Author for this publication
Published
2014-10-22
How to Cite
Trudeau, V., Gandaglia, G., Shiffmann, J., Popa, I., Shariat, S. F., Montorsi, F., Perrotte, P., Trinh, Q.-D., Karakiewicz, P. I., & Sun, M. (2014). Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes. Canadian Urological Association Journal, 8(9-10), e695-701. https://doi.org/10.5489/cuaj.2051
Section
Original Research