UTUC Treatment — Evidence & Guideline Recommendation

Lui Shiong LeeSingapore Moderator Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.

Yuki EndoJapan Speaker UTUC Treatment — Evidence & Guideline Recommendation "Current Status and Future Perspectives of Robot-Assisted Nephroureterectomy (RNU) in the Treatment of Upper Tract Urothelial Carcinoma (UTUC): Evidence and Guideline Recommendations" The standard treatment for upper tract urothelial carcinoma (UTUC) is surgical therapy. With the advancement of robot-assisted surgery, robotic procedures have become widespread in both upper and lower urinary tracts. In Japan, robot-assisted laparoscopic nephroureterectomy (RNU) for UTUC was included in health insurance coverage in 2019, and the proportion of RNUs for UTUC treatment is expected to increase. RNU, supported by robotic assistance, enables minimally invasive and precise procedures, allowing for reduced postoperative complications and shorter recovery periods (O'Sullivan et al., BJUI Compass. 2023). With further accumulation of data from randomized prospective trials and long-term follow-up studies, improvements in therapeutic outcomes, such as reduced postoperative recurrence, are anticipated. However, as a new technology, there is currently no established evidence. In a notable study, the only prospective randomized trial comparing laparoscopic nephroureterectomy (LNU) with open nephroureterectomy (ONU) showed no difference in disease-specific survival overall. However, in the pT3 or higher group, disease-specific survival and metastasis-free survival were significantly lower in the LNU group (Simone G et al., Eur Urol, 2009). Based on these results, both the European Association of Urology (EAU) guidelines and the Japanese Urological Association (JUA) guidelines recommend ONU for cT3 or higher stages. In addition, drug therapies, including immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs), are rapidly advancing, and reports of new clinical trials combining these therapies are changing the surgical strategies for MIUC. I would like to review the current positioning of RNU in each guideline and discuss cancer control points when performing RNU, which is expected to become more widespread, with the latest evidence.