Background <p>The purpose of this study was to evaluate the oncological and perioperative outcomes of robot-assisted bladder cuff excision (RA-BCE) versus open bladder cuff excision (O-BCE) after radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC).</p> Patients and methods <p>We conducted a multicenter study including all consecutive patients who underwent RA-BCE or O-BCE in eight French academic institutions from 2014 to 2023. Kaplan–Meier curves were used to illustrate survival outcomes, while uni- and multivariable Cox regression analyses were conducted to identify independent predictors of survival by calculating hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs).</p> Results <p>Overall, 487 patients underwent either RA-BCE (<i>n</i> = 182; 37.4%) or O-BCE (<i>n</i> = 305; 62.6%). The median follow up was 30.1 (26.9–36) months. Kaplan–Meier analyses showed that the use of RA-BCE versus O-BCE was associated with similar 3-year intravesical recurrence-free survival (RFS) (68.9% vs. 59.7%; <i>p</i> = 0.1), 3-year extravesical RFS (69.2 vs. 63.8%; <i>p</i> = 0.2), 3-year cancer-specific survival (CSS) (85.5% vs. 76.2%; <i>p</i> = 0.08), and 3-year overall survival (OS) (76% vs. 67.6%; <i>p</i> = 0.1). Multivariable Cox regression analyses confirmed that the use of RA-BCE versus O-BCE was associated with similar 3-year intravesical recurrence (HR 0.83; 95% CI&#xa0;0.55–1.26; <i>p</i> = 0.4), as well as similar 3-year extravesical recurrence (<i>p</i> = 0.8), 3-year CSS (<i>p</i> = 0.3), and 3-year OS (<i>p</i> = 0.3). Among 340 patients (69.8%) assessed, RA-BCE was associated with a lower rate of overall 90-day complications (<i>p</i> = 0.02), fewer major complications (<i>p</i> = 0.02), and a shorter length of stay (<i>p</i> &lt; 0.01).</p> Conclusions <p>Our multicenter study supports the effectiveness of RA-BCE versus O-BCE in the treatment of UTUC with comparable 3-year oncological outcomes.</p>