Category: Clinical Oncology: Outcomes & Complications

MP18-12 - The comparison of oncologic outcomes of transperitoneal and retroperitoneal radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) can be performed via transperitoneal or retroperitoneal approaches, and each one has its own advantages and limitations. However, no definitive conclusions regarding the two different surgical approaches in oncologic outcomes have been reached to date. To clarify this issue, we compared the oncologic outcomes between transperitoneal and retroperitoneal approaches in patients who underwent RNU for UTUC.


Methods : Medical records of eligible 743 patients who underwent RNU between February 1995 and December 2015 were retrospectively reviewed. Patients were divided into two groups according to RNU surgical approach method: retroperitoneal RNU (rRNU) or transperitoneal RNU (tRNU). Clinical characteristics and pathologic outcomes were compared between two groups. The influence of the method of surgical approach on progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan–Meier method, and differences were assessed with the log-rank test. Predictors of PFS, CSS, and OS were also analyzed with a multivariable Cox regression model.


Results :

Relative to the rRNU group, the tRNU group had more laparoscopic approach (P<0.001), more extravesical excision in the distal ureter management (P=0.026), and shorter follow-up duration (P=0.034). The 5-year CSS and OS rates were equivalent between the rRNU and tRNU, but the 5-year PFS was lower in the tRNU group compared to the rRNU group (P=0.005). When patients were stratified by pathological T stage, PFS was significantly different between the two groups in favor of the rRNU group for both organ-confined disease (pTis/pTa/pT1/pT2) (P=0.022) and locally advanced disease (pT3/pT4) (P=0.039). However, no significant differences in CSS and OS were observed when comparing the two groups for patients with organ-confined disease or patients with locally advanced disease. Subgroup analysis for patients who underwent laparoscopic RNU also revealed that patients in the rRNU group had a better PFS than those in the tRNU group (P=0.002), but CSS and OS of the two groups were similar. Furthermore, the tRNU was a significant predictor for PFS (hazard ratio=1.54; P=0.023), but not for CSS and OS. 


Conclusions : Our findings indicate that the rRNU approach led to better PFS compared with the tRNU for the management of patients with UTUC.

Tae Heon Kim

Clinical Assistant Professor
Department of Urology, CHA Bundang Medical Center, CHA University
Seongnam, Kyonggi-do, Republic of Korea

Tae Heon Kim, M.D., Ph.D.
Clinical Assistant Professor
Bundang CHA medical center

Seung Ryeol Lee

Department of Urology, CHA Bundang Medical Center, CHA University
Seongnam, Kyonggi-do, Republic of Korea

Young Kwon Hong

Department of Urology, CHA Bundang Medical Center, CHA University
Seongnam, Kyonggi-do, Republic of Korea

Dong Soo Park

Department of Urology, CHA Bundang Medical Center, CHA University
Seongnam, Kyonggi-do, Republic of Korea

Hwang Gyun Jeon

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Byong Chang Jeong

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Seong Il Seo

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Seong Soo Jeon

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Hyun Moo Lee

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Han Yong Choi

Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Hyun Hwan Sung

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
Seoul, Seoul-t'ukpyolsi, Republic of Korea