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Cancer Res Treat. 2019 Jul;51(3):963-972. doi: 10.4143/crt.2018.465. Epub 2018 Oct 12.

Laparoscopy versus Open Nephroureterectomy in Prognostic Outcome of Patients with Advanced Upper Tract Urothelial Cancer: A Retrospective, Multicenter, Propensity-Score Matching Analysis.

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Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea.
Biometrics Research Branch, Research Institute, National Cancer Center, Goyang, Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.



The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma.


The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Society of Anesthesiologists score, tumor location, grade, pathologic T and N categories, the presence of lymphovascular invasion, and follow-up duration. The Kaplan-Meier with log-rank tests and clustered Cox regression were used to compare the estimated rates of survival for each surgical approach and to investigate the effect of the surgical approach on each prognostic outcome.


Six hundred thirty-eight propensity-score matching pairs (n=1,276) were compared; LNU was significantly better than ONU in all types of survival, including intravesical recurrencefree survival (IVRFS), disease-free survival, overall survival (OS), and cancer-specific survival (CSS) (p < 0.05). The 3-year OS and CSS rates were significantly higher with LNU than with ONU (p < 0.05). Compared with ONU, LNU had significantly better 3-year OS and CSS rates (82.9% and 86.2% vs. 78.3% and 81.8%); there were no differences at 5 years. In subgroup analysis of the early-staged group, advanced-stage group, lymph node-positive group, and lymph node-negative group, the two approaches did not significantly affect prognostic outcomes, except LNU improved the IVRFS in the lymph node-negative or no history of previous bladder cancer group.


LNU had a significantly better prognostic outcome than ONU after propensity-score matching.


Laparoscopy; Nephroureterectomy; Prognosis; Survival; Urothelial carcinoma

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