Long-Term Oncologic Outcomes After Laparoscopic Radical Nephroureterectomy: A Contemporary Analysis From a Japanese Multicenter Cohort.

OBJECTIVES

To evaluate long-term oncologic outcomes and recurrence patterns after laparoscopic radical nephroureterectomy (LRNU) performed more than five years earlier.

PATIENTS AND

METHODS

We retrospectively analyzed patients who underwent LRNU before 2020 at nine Japanese institutions. Nonurothelial recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazard models were applied to identify prognostic factors. Initial recurrence sites were assessed, with particular focus on disseminated recurrence.

RESULTS

A total of 1102 patients were included, with a median follow-up of 57 months. Clinically locally advanced disease was observed in 212 patients (19%), including 178 (16%) with cT3-4 tumors and 64 (6%) with cN-positive disease. Lymphadenectomy was performed in 557 cases (51%). The 5-year RFS rates for pT < 1, pT1, pT2, pT3, and pT4 were 92%, 87%, 70%, 48%, and 20%, respectively. The corresponding CSS rates were 96%, 94%, 81%, 61%, and 21%, and the corresponding OS rates were 84%, 78%, 71%, 53%, and 15%. Older age at surgery and advanced pathological features were independent predictors of poorer RFS, CSS, and OS. Regarding recurrence patterns, distant recurrence occurred in 203 patients (18%), local recurrence in 127 (11%), and urothelial recurrence in 489 (45%). Disseminated recurrence was rare, occurring in 25 patients (2%), including 18 with retroperitoneal carcinomatosis and 3 (0.3%) with port-site recurrence.

CONCLUSIONS

Our findings suggest that LRNU provides favorable long-term oncologic outcomes with low disseminated recurrence rates, appearing comparable to historical outcomes of open surgery.