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

Nawar Hanna, Maxine Sun, Quoc Dien Trinh, Jens Hansen, Marco Bianchi, Francesco Montorsi, Shahrokh F. Shariat, Markus Graefen, Paul Perrotte, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)715-721
Number of pages7
JournalEuropean Urology
Issue number4
Publication statusPublished - Apr 2012


  • Complication
  • Laparoscopy
  • Nephroureterectomy
  • Outcome
  • Upper urinary tract carcinoma
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology


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