Single-position versus traditional retroperitoneal laparoscopic nephroureterectomy for UTUC: long-term survival and perioperative outcomes

Traditional retroperitoneal laparoscopic radical nephroureterectomy (TRLRNU) for upper tract urothelial carcinoma (UTUC) requires intraoperative repositioning, increasing operative time and risk. A modified single-position approach (SRLRNU) may improve perioperative efficiency. We retrospectively analyzed 276 UTUC patients who underwent either SRLRNU (n = 131) or TRLRNU (n = 145) from 2020 to 2024. In SRLRNU, patients remained in a fixed oblique lateral decubitus position throughout, enabling complete nephroureterectomy and bladder cuff excision without repositioning. Detailed surgical steps and port configurations were standardized and are presented in this study. Perioperative and oncologic outcomes were compared between groups. Survival analyses were conducted using Kaplan–Meier and Cox regression models. Subgroup analyses were performed according to tumor stage and pathological characteristics. The SRLRNU group showed significantly shorter operative time (124.47 ± 42.54 min vs. 160.11 ± 51.43 min, p < 0.001) and reduced blood loss (47.61 ± 140.75 ml vs. 71.45 ± 108.42 ml, p < 0.001), without compromising margin status or complication rates. No significant differences were observed in OS, CSS, PFS, or RFS between the two groups (all p > 0.05). Univariable and multivariable analysis suggested T stage, age, and ASA score as independent predictors of OS in the SRLRNU group. Hypoalbuminemia was significantly less frequent in the SRLRNU group (60.31% vs. 77.24%, p = 0.002). SRLRNU appears to be a safe and efficient alternative to TRLRNU, offering improved perioperative efficiency. Oncologic outcomes were comparable between groups during mid-term follow-up; however, given the retrospective design and follow-up imbalance, these findings should be interpreted as exploratory. Further studies with longer and more balanced follow-up are warranted.