Background: Radical nephroureterectomy (RNU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive techniques like robotic (RARNU) and laparoscopic (LRNU) RNU offer potential benefits over open surgery, but their comparative oncologic outcomes are debated. Methods: This retrospective, multicenter study analyzed 2037 Taiwanese patients undergoing RNU between 2010 and 2022. Missing data was addressed using multiple imputations. Overlap weighting was applied to balance patient characteristics between the RARNU and LRNU groups. Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. Results: After excluding the missing data, 405 patients underwent RARNU, and 1262 underwent LRNU. After adjusting for baseline differences, both groups showed comparable rates of surgical complications, residual tumor, UTUC-related mortality, and disease recurrence. The median follow-up was similar (52.4 vs. 51.6 months,p= 0.91). Using Kaplan-Meier survival curve analysis, overall survival, cancer-specific survival, and disease-free survival were similar between the two groups. Conclusions: This study shows that RARNU for UTUC has comparable oncological and perioperative outcomes to pure LRNU. RARNU may be easier for surgeons to adopt, particularly those with limited laparoscopic experience.
背景：根治性肾输尿管切除术（RNU）是上尿路尿路上皮癌（UTUC）的标准治疗方法。机器人辅助（RARNU）和腹腔镜（LRNU）等微创技术相较于开放手术具有潜在优势，但其肿瘤学结果的比较仍存在争议。方法：这项回顾性多中心研究分析了2010年至2022年间接受RNU治疗的2037名台湾患者。使用多重插补法处理缺失数据。应用重叠加权法平衡RARNU组与LRNU组患者的基线特征。采用Kaplan-Meier分析和Cox回归比较生存结局。结果：排除缺失数据后，405名患者接受了RARNU，1262名患者接受了LRNU。调整基线差异后，两组在手术并发症、残留肿瘤、UTUC相关死亡率及疾病复发率方面均表现相当。中位随访时间相近（52.4个月 vs. 51.6个月，p=0.91）。Kaplan-Meier生存曲线分析显示，两组的总生存期、癌症特异性生存期和无病生存期均无显著差异。结论：本研究表明，对于UTUC，RARNU与单纯LRNU具有相当的肿瘤学及围手术期结局。RARNU可能更易于外科医生掌握，尤其适用于腹腔镜经验有限的医师。
肿瘤(癌症)患者之家