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Vol. 47. Issue 7.
Pages 441-449 (September 2023)
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Vol. 47. Issue 7.
Pages 441-449 (September 2023)
Original article
Robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Peri and postoperative outcomes
Nefroureterectomía radical asistida por robot para el carcinoma urotelial del tracto urinario superior: resultados peri y postoperatorios
B. Mesnard
Corresponding author
benoit.mesnard@chu-nantes.fr

Corresponding author.
, S. de Vergie, I. Chelghaf, O. Bouchot, M.A. Perrouin Verbe, G. Karam, J. Branchereau, J. Rigaud
Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
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Tables (4)
Table 1. Pre-operative patient and tumour’s characteristics. Values expressed in median (IQR) or n (%).
Table 2. Evaluation of robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Intra-operative, early, and late post-operative outcomes. Values expressed in n (%) and median (IQR) or (Min-Max). Adverse events were graded according to the Clavien­Dindo system.
Table 3. Evaluation of robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Histological outcomes and oncological (n = 29). Values expressed in median (IQR) or n (%). Adverse events were graded according to the Clavien ­ Dindo system.
Table 4. Literature review.
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Abstract
Introduction

The treatment of urothelial tumours of the upper urinary tract at high risk of specific mortality is based on radical nephroureterectomy (RNU). Robotic-assisted laparoscopic radical nephroureterectomy (RARNU) is still under investigation to definitively establish the safety of this procedure in the management of urothelial tumours of the upper urinary tract. The primary objective is to evaluate the intra- and postoperative safety of RARNU and, subsequently, to evaluate the medium-term oncological results.

Methods

Our study is a retrospective, mono-centric study with a collection of RARNUs conducted between 1st January 2015 and 1st October 2021. The RARNUs were performed with the assistance of the Da Vinci Si® robot, then from 2017 the Da Vinci Xi® robot. Whenever possible, the entire procedure was carried out without re-docking.

Results

Between 1st January 2015 and 1st October 2021, 29 RARNUs were carried out at our centre. Complete surgery without re-docking was possible in 80% of cases with the Da Vinci Xi® robot. One patient required conversion to open surgery due to difficult dissection. 50% of tumours were classified as T3 or T4. The 30-day complication rate was 31%. The median length of hospitalisation was 5 days. The disease-free survival at the mean survival time (27.5 months) was of 75.2%. One patient had a recurrence in the nephrectomy compartment and no patient had a peritoneal or trocar orifice recurrence.

Conclusion

Performing RARNU for the management of tumours of the upper urinary tract appears to meet the criteria of surgical safety and those of oncological safety.

Keywords:
Urologic neoplasms
Upper tract carcinoma
Robotic surgical procedures
Nephroureterectomy
Resumen
Introducción

La nefroureterectomía radical (NUR) constituye el tratamiento de los tumores uroteliales del tracto urinario superior con alto riesgo de mortalidad específica. La nefroureterectomía radical laparoscópica asistida por robot (NURAR) todavía está siendo investigada para establecer de manera concluyente la seguridad del procedimiento en el tratamiento de los tumores uroteliales del tracto urinario superior. El objetivo principal es evaluar la seguridad intra y postoperatoria de la NURAR y, posteriormente, evaluar los resultados oncológicos a mediano plazo.

Métodos

Se trata de un estudio retrospectivo monocéntrico basado en una recopilación de NURAR realizadas entre el 1 de enero de 2015 y el 1 de octubre de 2021. Las NURAR se llevaron a cabo con la asistencia del robot Da Vinci Si® y, desde 2017, con el robot Da Vinci Xi®. Siempre que fue posible, la totalidad del procedimiento se llevó a cabo sin reacoplamiento (re-docking).

Resultados

Entre el 1 de enero de 2015 y el 1 de octubre de 2021, se realizaron 29 NURAR en nuestro centro. En el 80% de los casos se pudo realizar toda la cirugía sin reacoplamiento con el robot Da Vinci Xi®. Un paciente requirió conversión a cirugía abierta por dificultad en la disección. El 50% de los tumores se clasificaron como T3 o T4. La tasa de complicaciones a los 30 días fue del 31%. La duración media de la estancia hospitalaria fue de 5 días. La supervivencia libre de enfermedad en el tiempo medio de supervivencia (27,5 meses) fue del 75,2%. Un paciente tuvo una recidiva en el compartimento de la nefrectomía y ningún paciente tuvo recidiva peritoneal o en los orificios de los trocares.

Conclusión

La realización de NURAR para el tratamiento de los tumores del tracto urinario superior parece cumplir los criterios de seguridad quirúrgica y oncológica.

Palabras clave:
Neoplasias urológicas
Carcinoma del tracto urinario superior
Procedimientos quirúrgicos robóticos
Nefroureterectomía

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