As robotic surgery has been widely utilized in urological surgeries, there was an emerging trend toward robotic-assisted approach in managing Upper tract urothelial carcinoma(UTUC). The current evidence of robotic-assisted radical nephroureterectomy(RRNU) is still conflicting. Our study aimed to compare the perioperative outcomes and oncological outcomes between RRNU and laparoscopic radical nephroureterectomy(LRNU)

In this retrospective cohort study, we analyzed 442 patients diagnosed with UTUC without distant metastasis who had been treated with nephroureterectomy via robotic-assisted or laparoscopic approach. The information including baseline, surgery and tumor characteristics of patients was collected based on our database. Perioperative outcomes were compared between RRNU and LRNU groups and analyzed by chi-square test. Oncological outcomes including overall survival(OS), recurrence-free survival(RFS) and distant metastasis free survival (DFS) were assessed with Kaplan-Meier analysis. The hazard ratio for OS of RRNU was analyzed using the multivariate Cox regression hazards model.

There were a total of 391 patients meet the inclusion criteria and were included in the final analysis (RRNU: 83, LRNU: 308). Regarding the perioperative outcomes, RRNU group with the advantage of longer readmission days and lesser emergency readmission in 30 days. Major complication rate was lower in RRNU group (1.2% vs 4.2%), however, no significant difference was revealed. RRNU demonstrated with a superior oncological outcomes compared to LRNU. The OS at 5 years was 95.2%(RRNU) and 82.5%(LRNU), with a significant difference between the two groups (P= 0.004). Kaplan–Meier analysis revealed a significant disparity in OS, but not in RFS and DFS. RRNU was also associated with better OS (HR: 0.35, P=0.044) after multivariable cox regression analysis.

RRNU had superiority not only in perioperative outcomes but also oncological outcomes in managing non-metastatic UTUC. Therefore, RRNU demonstrated better safety and efficacy, and should be widely adopted as a first-line surgery approach.