SC132 - Surgical quality of robotic vs laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma: a multicenter retrospective analysis (ROBUUST collaborative group)

Abstract

Author of the Study: to evaluate the predictors of surgical quality (bladder cuff excision-lymph-node dissection-no complications-negative surgical margins) of robotic (RRNU) vs laparoscopic radical nephroureterectomy (LRNU) within a large multicenter study (ROBUUST collaborative group). Materials and Methods: the ROBUUST includes data of 17 centers worldwide regarding patients who underwent either RRNU or LRNU between 2015 and 2019. T≥2 any N, non-metastatic patients were assessed. An univariable and a multivariable logistic regression model including ASA≥3, multifocal tumor, pre-operative biopsy, history of bladder tumor, ureteroscopy, neoadjuvant chemotherapy, estimated blood loss, intraoperative complications and surgical approach to evaluate the predictors of surgical quality. Results: overall, 307 RRNU and 83 LRNU were included. In terms of baseline features, patients in the RRNU were more likely to have intrarenal cavities tumors (p < 0.001), lower hydronephrosis rate (p < 0.001), and lower cN+ (p = 0.02) compared to LRNU group. In terms of operative outcomes, patients in the RRNU had higher rate of bladder cuff excision (82.3% vs 57.8%; p < 0.001), lower rate of adjuvant bladder instillation (15% vs 33.7%; p < 0.001), higher major complications (18.6% vs 6.1%; p = 0.02), and shorter length of stay (p < 0.001).At multivariable analysis, LRNU showed to be not associated to surgical quality (OR: 0.22; p = 0.02) compared to RRNU. Conclusions: Within a large multi-institutional dataset worldwide, RRNU showed to present better surgical outcomes in terms of complications and length of stay compared to LRNU. In addition, laparoscopic approach seems to provide poorer surgical quality in terms of bladder cuff excision, lymphnode dissection, no complications and negative surgical margins.