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<p>To compare robot-assisted radical nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) using a probability-based multi-criteria decision analysis (MCDA) framework integrating perioperative, pathological, and mortality outcomes while explicitly modeling uncertainty. Comparative effect estimates were drawn from a published meta-analysis (O’Sullivan et al., 2023) of 29,987 patients (RANU 9,175; LNU 20,812). Six criteria were evaluated: overall morbidity, operative time, length of stay (LOS), estimated blood loss, positive surgical margins, and mortality. Effect estimates and 95% confidence intervals (CIs) informed normal distributions (log-odds scale for odds ratios). Outcomes were mapped to a 0–1 value scale using symmetric, clinically interpretable anchors. Uncertainty was assessed via Monte Carlo simulation (50,000 iterations). Five prespecified weighting scenarios (equal, safety-focused, oncology-focused, efficiency-focused, balanced) produced overall scores, rank probabilities, and pairwise net advantages. Sensitivity analysis evaluated anchor robustness. Under equal weighting, mean scores were 0.523 for RANU and 0.500 for LNU, with RANU preferred in 79.0% of simulations (net advantage, 0.023; 95% CI, − 0.032 to 0.079). RANU demonstrated higher preference probabilities in safety-focused (96.2%), oncology-focused (97.6%), and balanced (93.1%) scenarios, driven by lower morbidity and mortality. LNU was favored only when operative time and length of stay received dominant weight (RANU preference, 14.6%). Findings remained stable across anchor perturbations. When uncertainty and stakeholder preferences are incorporated, RANU demonstrates a higher probability of overall clinical benefit in safety- and oncology-focused settings; however, net advantage estimates showed uncertainty intervals overlapping zero in several scenarios, and these findings should not be interpreted as definitive clinical dominance. This probabilistic MCDA framework provides transparent, preference-aligned surgical decision-making.</p>

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Probabilistic multi-criteria decision analysis comparing robot-assisted and laparoscopic radical nephroureterectomy

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Shugo Yajima,
  • Soichiro Yoshida,
  • Wei Chen,
  • Hiroyuki Sato,
  • Akihiro Hirakawa,
  • Motohiro Fujiwara,
  • Minato Yokoyama,
  • Yuki Arita,
  • Hiroshi Fukushima,
  • Yosuke Yasuda,
  • Hajime Tanaka,
  • Hitoshi Masuda,
  • Yasuhisa Fujii

摘要

To compare robot-assisted radical nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) using a probability-based multi-criteria decision analysis (MCDA) framework integrating perioperative, pathological, and mortality outcomes while explicitly modeling uncertainty. Comparative effect estimates were drawn from a published meta-analysis (O’Sullivan et al., 2023) of 29,987 patients (RANU 9,175; LNU 20,812). Six criteria were evaluated: overall morbidity, operative time, length of stay (LOS), estimated blood loss, positive surgical margins, and mortality. Effect estimates and 95% confidence intervals (CIs) informed normal distributions (log-odds scale for odds ratios). Outcomes were mapped to a 0–1 value scale using symmetric, clinically interpretable anchors. Uncertainty was assessed via Monte Carlo simulation (50,000 iterations). Five prespecified weighting scenarios (equal, safety-focused, oncology-focused, efficiency-focused, balanced) produced overall scores, rank probabilities, and pairwise net advantages. Sensitivity analysis evaluated anchor robustness. Under equal weighting, mean scores were 0.523 for RANU and 0.500 for LNU, with RANU preferred in 79.0% of simulations (net advantage, 0.023; 95% CI, − 0.032 to 0.079). RANU demonstrated higher preference probabilities in safety-focused (96.2%), oncology-focused (97.6%), and balanced (93.1%) scenarios, driven by lower morbidity and mortality. LNU was favored only when operative time and length of stay received dominant weight (RANU preference, 14.6%). Findings remained stable across anchor perturbations. When uncertainty and stakeholder preferences are incorporated, RANU demonstrates a higher probability of overall clinical benefit in safety- and oncology-focused settings; however, net advantage estimates showed uncertainty intervals overlapping zero in several scenarios, and these findings should not be interpreted as definitive clinical dominance. This probabilistic MCDA framework provides transparent, preference-aligned surgical decision-making.