Oncologic Outcomes Following Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract XXXX .

@entity1 @entity1803 @entity66 @entity5 @entity189 @entity3041 @entity3 @entity1011
PURPOSE: Robot-assisted laparoscopic nephroureterectomy with bladder cuff excision is a minimally invasive alternative to open surgery for managing upper tract @entity189 . We report oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision. MATERIALS AND METHODS: The records of the initial 65 @entity1 who underwent robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract @entity189 between 2008 and 2014 were reviewed from our institutional review board approved, prospectively maintained database. All @entity1 underwent surgery with the single docking technique. Baseline demographic features, pathological variables and perioperative data were analyzed. Kaplan-Meier methodology was used for survival analysis. Cox proportional hazards regression was applied to determine the prognostic effect of different variables on survival. RESULTS: Mean @entity1 age was 69.1 years. Final pathological evaluation revealed pT2 stage or lower in 65% of @entity1 , @entity1803 in 28.3% and pT4 in 6.7%. High grade pathological findings were present in 85% of @entity1 , including 13.3% with @entity189 in situ and 30% with @entity3 . Median followup was 25.1 months (range 6 to 68.9). At 2 and 5 years overall survival was 86.9% and 62.6%, @entity5 specific survival was 92.9% and 69.5%, and recurrence-free survival was 65.3% and 57.1%, respectively. A total of 23 @entity1 experienced disease recurrence. Bladder recurrence developed in 15 @entity1 , 12 had isolated bladder recurrence and 8 had @entity3 . On univariate analysis age greater than 70 years, preoperative @entity3041 , @entity66 and @entity189 in situ were significantly associated with decreased recurrence-free survival (p  = 0.002, 0.04, 0.006 and 0.001, respectively). However, none was statistically significant on multivariate analysis. On univariate analysis impaired preoperative renal function ( @entity1011 greater than 2 mg/dl) and @entity3 were associated with reduced @entity5 specific survival (p = 0.03 and 0.01, respectively). However, only @entity3 was associated with @entity5 specific survival on multivariate analysis (p = 0.048). CONCLUSIONS: Our reported data on oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract @entity189 demonstrate satisfactory oncologic control at intermediate term followup. Long-term outcomes are required to assess true efficacy.
