Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group)

The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors. The ROBUUST 2.0 mult...

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Bibliographic Details
Published in:	Minerva urology and nephrology Vol. 76; no. 3; p. 331
Main Authors:	Ditonno, Francesco, Franco, Antonio, Veccia, Alessandro, Bologna, Eugenio, Wang, Linhui, Abdollah, Firas, Finati, Marco, Simone, Giuseppe, Tuderti, Gabriele, Helstrom, Emma, Correa, Andreas, DE Cobelli, Ottavio, Ferro, Matteo, Porpiglia, Francesco, Amparore, Daniele, Tufano, Antonio, Perdonà, Sisto, Bhanvadia, Raj, Margulis, Vitaly, Brönimann, Andres, Singla, Nirmish, Puri, Dhruv, Derweesh, Ithaar H, Mendiola, Dinno F, Gonzalgo, Mark L, Ben-David, Reuben, Mehrazin, Reza, Moon, Sol C, Rais-Bahrami, Soroush, Yong, Courtney, Moghaddam, Farshad Sheybaee, Ghoreifi, Alireza, Sundaram, Chandru P, Wu, Zhenjie, Djaladat, Hooman, Antonelli, Alessandro, Autorino, Riccardo
Format:	Journal Article
Language:	English
Published:	Italy 01-06-2024
Subjects:	Aged Carcinoma, Transitional Cell - mortality Carcinoma, Transitional Cell - pathology Carcinoma, Transitional Cell - surgery Female Humans Male Middle Aged Nephroureterectomy - methods Retrospective Studies Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods Treatment Outcome Ureter - surgery Ureteral Neoplasms - mortality Ureteral Neoplasms - pathology Ureteral Neoplasms - surgery
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Summary:	The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors. The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. 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. Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function. Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.
ISSN:	2724-6442
DOI:	10.23736/S2724-6051.24.05737-9