Comparing the perioperative outcomes of open radical nephroureterectomy and robot assisted nephroureterectomy using propensity score match analysis

You have accessJournal of UrologyCME1 Apr 2023PD46-12 COMPARING THE PERIOPERATIVE OUTCOMES OF OPEN RADICAL NEPHROURETERECTOMY AND ROBOT ASSISTED NEPHROURETERECTOMY USING PROPENSITY SCORE MATCH ANALYSIS Sheshang Kamath, Abhinav Veerwal, Akash Shah, and Thyavihally Yuvaraja Sheshang KamathSheshang Kamath More articles by this author , Abhinav VeerwalAbhinav Veerwal More articles by this author , Akash ShahAkash Shah More articles by this author , and Thyavihally YuvarajaThyavihally Yuvaraja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although Open radical nephroureterectomy (O-RNU) with bladder cuff excision (BCE) remains the gold standard for management of management of upper tract urothelial carcinoma, the trend has been changing globally towards minimal invasive surgery after the meta- analysis published by the European guidelines. We intend to specifically evaluate the intraoperative and post-operative aspects of Robot assisted nephroureterectomy (RANU) with BCE with respect to O-RNU with BCE for wider application RANU if feasible. METHODS: This study is a retrospectives study, the data of which was obtained from a prospectively maintained cancer registry of the oncology department in our tertiary care institute. The data was obtained between January 2011 and July 2022 from a single center operated by a single surgeon to avoid surgeon and institution bias. Univariate analysis was performed for baseline parameters, pathologic and perioperative outcomes among the two groups using Chi square test for categorical variables and student t-test was used for continuous variables. Multivariate logistic regression analysis was then performed. Propensity score match analysis (PSM) 1:1 was used to independently evaluate the lymph node yield, postoperative complications of Clavien Dindo grade 3 and above and time to discharge from the hospital after matching for the patient and tumor characteristics. The value of p considered significant was<0.05. RESULTS: Among 352 patients, 288 O-RNU and 64 RANU were performed. Median age of patient was 69 (IQR 54-71) in O-RNU and 70 (IQR 56-73) in RANU. Most common tumor stage for both arms was T2 (46.2 % in O-RNU vs 51.5% in RANU) Total operative time among both groups was higher in open surgery (180±17 minutes in O-RNU vs 153±10 minutes in RANU. Perioperative factors significantly improved among RANU group was lymph node yield, Clavien Dindo complications 3 or more and time to discharge in multivariate logistic regression. PSM 1:1 done for 64 nephroureterectomies in each group matched for baseline patient and tumor variables found only time to discharge and readmission rates to be significantly lesser in the RANU group. CONCLUSIONS: Although cost of surgery increases, propensity score analysis shows readmission rates and hospital stay significantly lesser in the robotic group, thereby significantly impacting the post-operative wellbeing of the patients. The retrospective nature of the study remains a drawback of this study, however we feel this study should urge more intuitions across the globe to start implementing RANU to give a prospective and global perspective. Source of Funding: We have no source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1174 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sheshang Kamath More articles by this author Abhinav Veerwal More articles by this author Akash Shah More articles by this author Thyavihally Yuvaraja More articles by this author Expand All Advertisement PDF downloadLoading ...