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Volume 61, issue 4, pages e23-e40, April 2012

Urothelial Cancer

Reply from Authors re: Brant A. Inman. Open Versus Laparoscopic Nephroureterectomy: Is There Really a Debate? Eur Urol 2012;61:722–3

Nawar Hanna a b lowast , Maxine Sun a, Marco Bianchi a c and Pierre I. Karakiewicz a b

Published online 1 February 2012, page 724

Full Text Full-Text PDF (46 KB)

Refers to article:

Open Versus Laparoscopic Nephroureterectomy: Is There Really a Debate?

Brant A. Inman

April 2012 (Vol. 61, Issue 4, pages 722 - 723)

Full Text Full-Text PDF (85 KB)

Refers to article:

Propensity-Score-Matched Comparison of Perioperative Outcomes Between Open and Laparoscopic Nephroureterectomy: A National Series

Nawar Hanna, Maxine Sun, Quoc-Dien Trinh, Jens Hansen, Marco Bianchi, Francesco Montorsi, Shahrokh F. Shariat, Markus Graefen, Paul Perrotte and Pierre I. Karakiewicz

Accepted 13 December 2011

April 2012 (Vol. 61, Issue 4, pages 715 - 721)

Abstract Full Text Full-Text PDF (0,9 MB)

Article Outline

We read with interest the editorial comment made by Inman [1] on our recent paper that compared short-term in-hospital outcomes between open nephroureterectomy (ONU) versus laparoscopic nephroureterectomy (LNU) [2]. The propositions made within the comment summarize the inherent considerations that should be accounted for, not only of our report, but also of the bulk of existing literature addressing the same topic [3], [4], [5], [6], and [7]. Given the low incidence and rarity of upper tract urothelial carcinomas (UTUCs) [8], it is not surprising that no randomized trial has been designed to compare morbidity or mortality between ONU and LNU. In the future, despite the necessity, such a trial will remain unlikely to happen. What is left are institutional and population-based data, both study cohorts holding advantages and disadvantages of their own. Ultimately, the goal of all such reports is to reach a consensus for both the patient and the clinician. To date, no study, including our recent report [2], can reliably and validly cover all the unknowns of the topic. Nonetheless, the totality of all such reports, whether institutional or population based, prospectively or retrospectively designed, sheds light on what has been addressed as well as what remain to be addressed.

Our group, along with other investigators, have confirmed the potential role of LNU for the treatment of patients diagnosed with UTUC, both within centers of excellence and within the community [2], [3], [4], [6], and [7]. Future studies will likely address the details that were lacking in such reports and possibly answer some questions that remain to be resolved. We agree with Inman that a formal comparison with a randomization factor will likely diminish the selection biases often present in retrospective cohorts. Nonetheless, such a trial may never occur. Even if it would, one cannot dismiss findings from existing studies that sought to address the paucity of data based on their observational or retrospective nature.

Conflicts of interest

The authors have nothing to disclose.

References

  • [1] B.A. Inman. Open versus laparascopic nephroureterectomy: is there really a debate?. Eur Urol. 2012;61:722-723 Abstract, Full-text, PDF, Crossref.
  • [2] N. Hanna, M. Sun, Q.-D. Trinh, et al. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol. 2012;61:715-721 Abstract, Full-text, PDF, Crossref.
  • [3] M.M. Ariane, P. Colin, A. Ouzzane, et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol. 2012;19:301-308 Crossref.
  • [4] R.L. Favaretto, S.F. Shariat, D.C. Chade, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique?. Eur Urol. 2010;58:645-651 Abstract, Full-text, PDF, Crossref.
  • [5] J.D. Raman, M.A. Palese, C.K. Ng, et al. Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. JSLS.. 2006;10:432-438
  • [6] G. Simone, R. Papalia, S. Guaglianone, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009;56:520-526 Abstract, Full-text, PDF, Crossref.
  • [7] M. Waldert, M. Remzi, H.C. Klingler, L. Mueller, M. Marberger. The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy. BJU Int. 2009;103:66-70 Crossref.
  • [8] J.D. Raman, J. Messer, J.A. Sielatycki, C.S. Hollenbeak. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int. 2011;107:1059-1064 Crossref.
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Footnotes

a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

b Department of Urology, University of Montreal Health Center, Montreal, Canada

c Department of Urology, Vita Salute San Raffaele University, Milan, Italy

lowast Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Hospital St-Luc, 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. Tel. +1 514 890 8000 ext. 35335; Fax: +1 514 227 5103.

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