Comparison of survival outcomes between laparoscopic versus open radical nephroureterectomy in upper tract urothelial cancer patients:Experiences of a tertiary care single center

Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database.Patients undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study population.Patients with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were excluded.Tabulation was performed according to the laparoscopic versus open surgical approach.Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach.Furthermore,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.Results:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open nephroureterectomy.Patient and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),respectively.The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.Conclusions:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU.Furthermore,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.

Radical prostatectomy in patients aged 75 years or older:review of the literature

Given the demographic trends toward a considerably longer life expectancy,the percentage of elderly patients with prostate cancer will increase further in the upcoming decades.Therefore,the question arises,should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making,life expectancy is more important than biological age.As a result,a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit.As perioperative morbidity and mortality in these patients is increased relative to younger patients,patient selection according to comorbidities is a key issue that needs to be addressed.It is known from the literature that elderly men show notably worse tumor characteristics,leading to worse oncologic outcomes after treatment.Moreover,elderly patients also demonstrate worse postoperative recovery of continence and erectile function.As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years,a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless,patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.