Comparing Laparoscopic Versus Open Nephroureterectomy for Patients With UTUC

In patients with upper tract urothelial carcinoma (UTUC), there is a lack of research on the effectiveness of laparoscopic nephroureterectomy (LNU) compared with open nephroureterectomy (ONU).

A meta-analysis of studies conducted by Shidong Deng, MM, and colleagues published in Surgical Innovation and drawn from propensity score-matched cohorts sought to determine the surgical and oncological outcomes of LNU and ONU in patients with UTUC.

Researchers utilized the Newcastle-Ottawa Scale to review the quality of eligible studies and carried out a literature search of PubMed, Embase, and Cochrane Library up to July 2023. Surgical and oncological outcomes measurements were extracted and pooled, including mean difference, risk ratio, hazard ratio, and 95% CI.

Of the reviewed studies, 5 were included in the research. These studies featured 6422 patients, of whom 2080 (32.4%) received LNU and 4342 (67.6%) underwent ONU.

Patients who underwent LNU reported less estimated blood loss and shorter hospital stays than patients in the ONU cohort. Investigators reported little difference in complication rates and operation time.

Between the LNU and ONU groups, Dr. Deng and colleagues noted that there was little difference in overall survival (OS) and cancer-specific survival (CSS). In the LNU cohort, 3-year intravesical recurrence-free survival (IVRFS) was worse when compared with the ONU cohort.

“LNU was associated with less estimated blood loss and shorter hospital stays than ONU, but there were no differences in OS and CSS between the surgical modalities,” the investigators wrote. “Nonetheless, LNU might result in poorer IVRFS than ONU.”