Robotic Versus Laparoscopic Radical Nephroureterectomy in UTUC

Key Takeaways

• Perioperative outcomes were comparable, and no remarkable differences were reported in disease-free or overall survival.
• Surgical platform was not significantly associated with cancer-specific mortality or intravesical recurrence in the overall cohort.
• Intravesical recurrence was reported less often after robot-assisted surgery in pathological T3 disease, and the signal was framed as exploratory and hypothesis-generating.

In aJournal of Robotic Surgery report, pathological T3 disease showed intravesical recurrence in 7.3% of robot-assisted cases and 27.3% of laparoscopic cases after radical nephroureterectomy with bladder cuff excision. The retrospective comparison covered consecutive patients treated from August 2014 through July 2025 and examined minimally invasive surgery for upper tract urothelial carcinoma. It compared robot-assisted and laparoscopic radical nephroureterectomy with bladder cuff excision in the same disease setting. 

This retrospective analysis included consecutive patients with upper tract urothelial carcinoma who underwent minimally invasive radical nephroureterectomy with bladder cuff excision. Patients were stratified by surgical platform into laparoscopic and robot-assisted groups for perioperative and oncologic comparison across the treatment period. The cohort comprised 287 patients, including 152 treated with LNU and 135 treated with RANU. The treatment window ran from August 2014 to July 2025, with reporting of perioperative and survival outcomes. 

Estimated blood loss, theater time, and major complication rates did not differ significantly between the two minimally invasive approaches. During follow-up, no remarkable differences were identified in disease-free survival or overall survival between the groups. Fine–Gray competing risk regression was used to evaluate cancer-specific mortality and intravesical recurrence in the overall cohort. That analysis did not show a statistically significant correlation between surgical platform and either endpoint. The clearest separation between platforms appeared within the pathological T3 subgroup rather than across the full cohort.

That subgroup signal remained the notable exception, with the pathological T3 intravesical recurrence comparison reaching statistical significance at p=0.016 in the pathological T3 intravesical recurrence analysis. In exploratory multivariable analysis, robot-assisted surgery was associated with a decreased likelihood of intravesical recurrence, with a subdistribution hazard ratio of 0.275 and p=0.041.