Laparoscopic versus robot-assisted nephroureterectomy for management of upper-tract urothelial carcinoma

Upper tract urothelial carcinoma (UTUC) is a rare urothelial malignancy. Radical nephroureterectomy (RNU) remains the standard of care for UTUC. Use of robot-assisted nephroureterectomy (RANU) has grown to be the favored approach for management of UTUC. The present study aimed to compare operative and postoperative outcomes of laparoscopic nephroureterectomy (LNU) and RANU in studies with matched and unmatched cohorts. The present study was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. Selected keywords and MeSH (Medical Subject Headings) terms were used to search Web of Science, Scopus and Pubmed databases for relevant literature. Quality of studies included in this work were assessed using the Newcastle–Ottawa scale (NOS) for cohort studies. Extracted data were statistically analyzed and presented using Revman software. The 21 studies included in this meta-analysis were conducted on 32,882 patients. They comprised 22,624 patients (68.8%) who underwent LNU and 10,258 patients (31.2%) who underwent RANU. There were 7 studies that compared matched cohorts (19,984 patients, 60.8%) and 14 studies that compared unmatched groups (12,898 patients, 39.2%). RANU was associated with shorter duration of hospital stay in studies with matched cohorts, [mean difference (95% CI): 1.65 (0.49—2.81)], studies with unmatched cohorts [mean difference (95% CI): 0.93 (0.35—1.50)], and in all studies [mean difference (95% CI): 1.13 (0.66—1.60)]. Also, it was found that RANU was associated with significantly higher odds of lymph node dissection in the matched cohorts’ studies [OR (95%): 0.58 (0.43–0.79)], unmatched cohorts’ studies [OR (95%): 0.39 (0.30–0.51)] and all studies [OR (95% CI): 0.44 (0.35–0.55)]. Pooled analysis of all studies, studies with matched cohorts and studies with unmatched cohorts found that LNU and RANU had comparable operative duration, frequency of positive surgical margin, frequency of intraoperative complications, frequency of overall postoperative complications and frequency of hospital readmission. Discrepancies existed between different subsets regarding harvested lymph nodes count, estimated blood loss, major postoperative complications, postoperative blood transfusions and postoperative mortality. RANU had shorter hospital stay and higher odds of lymph node dissection. Also, RANU had comparable operative duration, frequency of positive surgical margin, frequency of intraoperative complications frequency of overall postoperative complications and frequency of hospital readmission when compared with LNU regardless cohorts matching.