A Single-Center Comparison Of Different Surgical Approaches For Full-Length Renal-Ureteral Resection For Upper Urinary Tract Uroepithelial Carcinoma

Purpose:The intraoperative and postoperative parameters of robotic one-piece surgery,modified one-piece complete laparoscopic surgery,and posterior laparoscopicassisted Gibson incision surgery for upper urinary tract uroepithelial carcinoma(UTUC)patients undergoing total nephroureterectomy(NU)were compared and analyzed to comprehensively assess the differences between the three procedures for the treatment of upper urinary tract uroepithelial carcinoma.Materials and methods:Retrospective analysis of 82 patients who underwent robotic one-piece surgery,modified one-piece complete laparoscopic surgery,or posterior laparoscopic-assisted Gibson incision full-length nephro-ureterectomy combined with cystic sleeve resection at our center with pathological diagnosis of UTUC from March 2019 to September 2022 and obtained postoperative pathological confirmation.They were divided into RANU group(total 17 cases),CTLNU group(total 12 cases)and RLNU group(total 53 cases)according to the surgical method.General basic information,tumor-related indexes(tumor location,tumor side,tumor stage),as well as intraoperative bleeding,operative time,positive surgical margin rate,intermediate transfer to other surgeries,postoperative resumption of ventilation,drainage tube removal time,catheter retention time,postoperative complication rate,postoperative hospitalization days,and postoperative tumor recurrence were collected and analyzed in subgroups for each of the three groups,respectively.Patients were followed up for more than 6 months postoperatively.Results:There were 17 patients in the RANU group,12 patients in the CTLNU group,and 53 patients in the RLNU group.No significant differences were found in the general data of age,gender,BMI,tumor location,tumor side,tumor stage,and general history of underlying diseases(hypertension or diabetes mellitus)among the three groups.All patients completed the surgery in a single visit,without any conversion to other surgical procedures,and the negative surgical margin rate was100% in all three groups.There were no significant differences in intraoperative bleeding,catheter retention time and tumor recurrence among the three groups.the operative time was significantly longer in the RANU group than in the RLNU and CTLNU groups(P=0.004);the postoperative resumption of ventilation was significantly shorter in the RANU and RLNU groups than in the CTLNU group(RANU vs.CTLNU,P=0.018;RLNU vs.CTLNU,P= 0.000);the RANU group was significantly better than the CTLNU and RLNU groups in terms of time to complete drainage tube removal(P=0.005);the number of postoperative hospital days was significantly less in the RANU group than in the CTLNU and RLNU groups(P=0.049);and the RANU group was significantly better than the CTLNU and RLNU groups in terms of postoperative complication rate(P=0.035).Conclusion:Compared with the CTLNU and RLNU groups,the RANU group had less intraoperative bleeding,postoperative complication rate,drainage tube removal time,and hospitalization time;the RLNU group had more advantages in terms of operative time and postoperative resumption of ventilation;the CTLNU group was more in between,but had less operative costs than the RANU group.There was no significant difference in catheter removal time and postoperative recurrence among the three groups.