Comparison Of The Efficacy Of Complete Laparoscopic And Traditional Laparoscopic Nephroureterectomy

Objective: To compare the efficacy and safety of complete laparoscopic nephroureterectomy(CLNU)and traditional laparoscopic nephroureterectomy(TLNU)for upper urinary tract urothelial carcinoma(UTUC).Methods: The clinical data of patients with UTUC admitted to the Department of Urology,Shengjing Hospital,China Medical University from January 2017 to December2021 were retrospectively analyzed,a total of 134 patients were finally included according to the strict inclusion and exclusion criteria.Among them,47 patients were in the CLNU group and 87 patients were in the TLNU group.Patients in both groups were matched 1:1 for propensity score matching(PSM)based on factors such as clinical and pathological information.The nearest neighbor matching method was used,the caliper width was taken as 0.1,and the finally match was 44 pairs of patients.Then the differences in basic clinical data,perioperative parameters,prognosis and other relevant information were compared between the two groups.Results: Before PSM the two groups were statistically different in BMI and smoking history(P < 0.05),after PSM there was no statistical difference in baseline information between the two groups(P > 0.05).The intraoperative bleeding in the CLNU group was significantly less than in the TLNU group(100.00(20.00,200.00)ml vs.100.00(100.00,200.00)ml,P=0.045).The intestinal recovery time in the CLNU group was less than in the TLNU group(2.00(2.00,3.00)days vs 3.00(3.00,4.00)days,P=0.036).There was no statistically significant difference between the two groups in terms of operative time,drainage time,postoperative hospital stay and postoperative complications(P > 0.05).Median follow-up time was 36.0(29.0,41.0)months in the TLNU group and 24.0(19.0,44.0)months in the CLNU group.There was no statistical difference between the two groups in terms of overall survival(OS)and recurrence free survival(RFS)(P > 0.05).Conclusion: Compared to TLNU,CLNU was effective in reducing intraoperative bleeding and intestinal recovery time.There was no significant difference in terms of operative time,drainage time,postoperative hospital stay and postoperative complications.Meanwhile,there was no significant difference in OS and RFS.