Robot‐assisted nephroureterectomy: surgical and mid‐term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group)

• Published in: BJU international Vol. 134; no. 6; pp. 967 - 975
• Main Authors: Ditonno, Francesco, Franco, Antonio, Wu, Zhenjie, Wang, Linhui, Abdollah, Firas, Simone, Giuseppe, Correa, Andres F., Ferro, Matteo, Perdonà, Sisto, Amparore, Daniele, Bhanvadia, Raj, Brönimann, Stephan, Puri, Dhruv, Mendiola, Dinno F., Ben‐David, Reuben, Moon, Sol C., Yong, Courtney, Moghaddam, Farshad S., Ghoreifi, Alireza, Bologna, Eugenio, Licari, Leslie Claire, Finati, Marco, Tuderti, Gabriele, Helstrom, Emma, Tozzi, Marco, Tufano, Antonio, Rais‐Bahrami, Soroush, Sundaram, Chandru P., Mehrazin, Reza, Gonzalgo, Mark L., Derweesh, Ithaar H., Porpiglia, Francesco, Singla, Nirmish, Margulis, Vitaly, Antonelli, Alessandro, Djaladat, Hooman, Autorino, Riccardo
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2024
• Subjects: Complications; Glomerular filtration rate; Metastases; Morbidity; oncological outcomes; Postoperative; radical nephroureterectomy; Robotic surgery; robotic surgical procedure; surgical complications; Survival; Survival analysis; upper urinary tract urothelial cancer; Urinary tract; Urothelial cancer; Urothelial carcinoma; oncological outcomes; surgical complications; robotic surgical procedure; radical nephroureterectomy; upper urinary tract urothelial cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.16526

Objective
To analyse surgical, functional, and mid‐term oncological outcomes of robot‐assisted nephroureterectomy (RANU) in a contemporary large multi‐institutional setting.
Patients and Methods
Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time‐to‐event outcomes were: recurrence‐free survival (RFS), metastasis‐free survival (MFS), cancer‐specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan–Meier method, with a 3‐year cut‐off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome.
Results
A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of −13.1 (−27.5 to 0) mL/min/1.73 m2 from baseline was observed. The 3‐year RFS was 59% and the 3‐year MFS was 76%, with a 3‐year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder‐cuff excision, high‐grade tumour, pathological T stage ≥3, and nodal involvement.
Conclusions
The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid‐term oncological outcomes, mirroring those of open NU, even in non‐organ‐confined disease.