Refers to article:
Comparison Between Laparoscopic and Open Radical Nephroureterectomy in a Contemporary Group of Patients: Are Recurrence and Disease-Specific Survival Associated with Surgical Technique?
Accepted 3 August 2010
November 2010 (Vol. 58, Issue 5, pages 645 - 651)
Multiple comparative studies aimed to determine whether the minimally invasive laparoscopic radical nephroureterectomy (LRN) will provide noninferior efficacy of cancer control for upper-tract urothelial carcinoma (UTUC) , , and ; however, the conclusions based on these results are underpowered due to different statistical models. The factor of UTUC tumor location should be included in the model because the predictive significance of tumor location remains controversial. Additionally, cigarette smoking status should be included in the analysis because exposure to smoking is a significant risk factor for bladder urothelial carcinoma as well as UTUC.
The well-controlled study reported by Favaretto et al.  has some strengths, such as centralized pathologic review and standardized follow-up protocol; however, the major drawbacks include enrolling patients with previous non-muscle-invasive bladder cancer (NMIBC) and not clearly introducing the situations of patients with NIMBC, such as the mean time free from recurrence, whether NMIBC has been well controlled, and any continuous maintenance intravesical chemotherapy. Furthermore, as noted in the comments by Zisman , who preferred LRN for patients with low risk of metastatic disease and classical open radical nephroureterectomy with or without retroperitoneal lymph node dissection for higher risk disease, surgeon preference might result in a significant selection bias. In the literature, only one prospective randomized study in which the operations were performed by a single surgeon could eliminate the confounding effect; however, the sample size was relatively small .
In summary, a well-designed, large-scale, and randomized study is warranted to confirm the efficacy of LRN.
Conflicts of interest
The authors have nothing to disclose.
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a Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
b Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei
© 2010 European Association of Urology, Published by Elsevier B.V.