Laparoscopic and open nephroureterectomy for upper urinary tract urothelial-cell carcinoma (UUT-UCC), which are uncommon but aggressive malignancies, are associated with comparable long-term outcomes, Scottish investigators concluded.
The researchers, led by Grant D. Stewart, MBChB, PhD, of the University of Edinburgh, studied 62 patients with UUT-UCC, of whom 39 underwent open nephroureterectomy (ONU) and 23 underwent laparoscopic nephroureterectomy (LNU).
The median follow-up was 163 months (13.6 years). The estimated mean overall survival (OS) was 111 and 103 months for ONU and LNU, respectively, Dr. Stewart’s group reported in the Journal of Endourology (2011;25:1329-1335). Mean progression-free survival (PFS) was 175 months for ONU and 143 months for LNU. The probability of PFS at 10 years was 79% for ONU and 76% for LNU and unchanged at 15 years. OS, PFS, and cancer-specific survival were similar for the two groups. After adjusting for confounding variables, the investigators found no prognostic differences between the procedures.
“The results of this study help to confirm that we have now reached a stage where LNU can be recommended as the first choice for UUT-UCC, necessitating extirpative treatment,” the authors concluded.
In the absence of a randomized controlled trial, which is unlikely to be performed, a meta-analysis of studies with prolonged follow-up, such as the present study, “should be conducted to obtain results with satisfactory statistical power,” the authors noted.