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Background <p>Upper tract urothelial carcinoma (UTUC) is a relatively rare but clinically significant form of urothelial carcinoma, accounting for 5–10% of all urothelial malignancies. Effective surgical management is crucial for improving patient outcomes. This multicenter propensity score-matched study compares the long-term efficacy and perioperative outcomes of transperitoneal laparoscopic nephroureterectomy (T-LNU) and retroperitoneal laparoscopic nephroureterectomy (R-LNU) in patients with UTUC, with a median follow-up of 52&#xa0;months. </p> Methods <p>A retrospective analysis was conducted on data from patients diagnosed with primary UTUC who underwent laparoscopic nephroureterectomy (LNU) across three institutions from January 2014 to June 2022. Propensity score matching (PSM) was performed to adjust for potential selection bias. The primary outcomes included overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), and metastasis-free survival (MFS). The secondary outcomes included perioperative indicators such as surgical duration, blood loss, and postoperative recovery.</p> Results <p>A total of 396 patients were included, with 278 undergoing R-LNU and 118 undergoing T-LNU. After 1:1 propensity score matching, 202&#xa0;patients (101 in each group) were analyzed. No significant differences were observed in long-term outcomes between the two groups. However, T-LNU was associated with a significantly shorter surgical duration (median 210&#xa0;min vs. 240&#xa0;min, <i>p</i> = 0.003), while R-LNU was associated with quicker postoperative gastrointestinal recovery (<i>p</i> = 0.005).</p> Conclusion <p>Both T-LNU and R-LNU are effective surgical approaches for UTUC, each with distinct advantages. The choice of approach should be tailored to individual patient factors and surgeon expertise. Further studies with larger sample sizes and longer follow-up periods are needed to definitively determine the optimal approach for LNU in patients with UTUC.</p>

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Comparative efficacy of transperitoneal and retroperitoneal laparoscopic nephroureterectomy for upper tract urothelial carcinoma: a multicenter propensity score-matched study

  • 期刊论文

  • 发表日期：

    2025年7月7日

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  • Cheng Wang,
  • ShuZhen Ou,
  • Xuan Li,
  • Biao Zhang,
  • Shujun Yang,
  • XinYue Lai,
  • Ziming Kang,
  • WanRong Xu,
  • HengPing Li,
  • JiangHou Wan,
  • PanFeng Shang

摘要

Background

Upper tract urothelial carcinoma (UTUC) is a relatively rare but clinically significant form of urothelial carcinoma, accounting for 5–10% of all urothelial malignancies. Effective surgical management is crucial for improving patient outcomes. This multicenter propensity score-matched study compares the long-term efficacy and perioperative outcomes of transperitoneal laparoscopic nephroureterectomy (T-LNU) and retroperitoneal laparoscopic nephroureterectomy (R-LNU) in patients with UTUC, with a median follow-up of 52 months.

Methods

A retrospective analysis was conducted on data from patients diagnosed with primary UTUC who underwent laparoscopic nephroureterectomy (LNU) across three institutions from January 2014 to June 2022. Propensity score matching (PSM) was performed to adjust for potential selection bias. The primary outcomes included overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), and metastasis-free survival (MFS). The secondary outcomes included perioperative indicators such as surgical duration, blood loss, and postoperative recovery.

Results

A total of 396 patients were included, with 278 undergoing R-LNU and 118 undergoing T-LNU. After 1:1 propensity score matching, 202 patients (101 in each group) were analyzed. No significant differences were observed in long-term outcomes between the two groups. However, T-LNU was associated with a significantly shorter surgical duration (median 210 min vs. 240 min, p = 0.003), while R-LNU was associated with quicker postoperative gastrointestinal recovery (p = 0.005).

Conclusion

Both T-LNU and R-LNU are effective surgical approaches for UTUC, each with distinct advantages. The choice of approach should be tailored to individual patient factors and surgeon expertise. Further studies with larger sample sizes and longer follow-up periods are needed to definitively determine the optimal approach for LNU in patients with UTUC.