Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience.

Campi, Riccardo; Cotte, Juliette; Sessa, Francesco; Seisen, Thomas; Tellini, Riccardo; Amparore, Daniele; Mormile, Nicola; Gobert, Aurélien; Mari, Andrea; Porpiglia, Francesco; Serni, Sergio; Minervini, Andrea; Rouprêt, Morgan

Purpose: To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). Methods: Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. Results: 81 patients were included. No case required conversion to open surgery. Early major (Clavien–Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was − 1 ml/min/1.73 m2 after SU and − 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. Conclusion: Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.

TRANSITIONAL cell carcinoma; PERITONEAL cancer; ROBOTICS; SURGICAL site; KIDNEY pelvis

World Journal of Urology, 2019, Vol 37, Issue 11, p2303

0724-4983

Academic Journal

10.1007/s00345-019-02790-y