Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series

Eur Urol. 2012 Apr;61(4):715-21. doi: 10.1016/j.eururo.2011.12.026. Epub 2011 Dec 22.


Background: Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort.

Objectives: Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort.

Design, setting, and participants: We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients.

Intervention: All patients underwent NU.

Measurements: The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching.

Results and limitations: For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p<0.001); intraoperative complications, 4.7% versus 2.1% (p=0.002); postoperative complications, 17% versus 15% (p=0.24); pLOS (≥5 d), 47% versus 28% (p<0.001); in-hospital mortality, 1.3% versus 0.7% (p=0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p<0.001), to experience any intraoperative complications (OR: 0.4; p=0.002), and to have a pLOS (OR: 0.4; p<0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p=0.007). This study is limited by its retrospective nature.

Conclusions: After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Transfusion
  • Chi-Square Distribution
  • Databases, Factual
  • Female
  • Hospital Mortality
  • Humans
  • Inpatients
  • Laparoscopy* / adverse effects
  • Laparoscopy* / mortality
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nephrectomy / adverse effects
  • Nephrectomy / methods*
  • Nephrectomy / mortality
  • Odds Ratio
  • Postoperative Complications / etiology
  • Propensity Score
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States
  • Ureter / pathology
  • Ureter / surgery*
  • Urologic Neoplasms / mortality
  • Urologic Neoplasms / pathology
  • Urologic Neoplasms / surgery*
  • Urothelium / pathology
  • Urothelium / surgery*
  • Young Adult