Minimally invasive surgeries including laparoscopic and robotic surgery for upper tract urothelial carcinoma raises concerns about the risk of tumor dissemination, and long-term oncologic outcomes, particularly for locally advanced cases, remain limited. This study aimed to evaluate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) performed more than five years ago.

A retrospective multicenter analysis was conducted using data from nine Japanese institutions. Patients who underwent LRNU between 2000 and 2020 were analyzed. Kaplan-Meier survival analysis was used to assess recurrence-free survival (RFS) and cancer-specific survival (CSS). Cox proportional hazards modeling was performed to identify factors associated with recurrence. Initial recurrence sites were examined, with a particular focus on the incidence of disseminated recurrence.

A total of 1,102 cases were analyzed, with a median follow-up of 57 months. The cohort included 611 renal pelvic tumors (55%) and 525 ureteral tumors (48%), with 34 cases (3%) involving both sites. Clinical stage cT3 or higher was observed in 178 cases (16%), and cN-positive disease in 64 cases (6%). According to the EAU guidelines, 86 cases (8%) were classified as low-risk, 358 (33%) as weak high-risk, and 658 (60%) as strong high-risk. Neoadjuvant chemotherapy was administered in 39 cases (4%), adjuvant chemotherapy in 184 cases (17%), and lymphadenectomy in 568 cases (52%). The RFS rates for pT <1, pT1, pT2, pT3, and pT4 were 92%, 87%, 70%, 48%, and 20%, respectively, while CSS rates were 96%, 94%, 81%, 61%, and 21%, respectively. Extravesical recurrence occurred in 325 cases (29%), with recurrence sites including lymph nodes (13%), lungs (10%, n=108), liver (5%, n=52), local recurrence (3%, n=35), and bone (3%, n=32). Suspected disseminated recurrence was observed in 17 cases (2%) in the retroperitoneum and in 3 cases (0.3%) at port sites. Age at surgery, non-organ-confined disease, high tumor grade, and lymphovascular invasion were identified as prognostic factors for both RFS and CSS.

The long-term oncologic outcomes of LRNU were comparable to those previously reported for open radical nephroureterectomy. The incidence of disseminated recurrence was low, suggesting that LRNU maintains oncologic safety.