Robotic segmental ureterectomy for upper tract urothelial carcinoma: comparable short-term oncological outcomes and improved postoperative recovery compared to open approach

Background: Segmental ureterectomy (SU) is an established kidney-sparing strategy for upper tract urothelial carcinoma (UTUC), yet few studies have compared the standard open approach to the emerging robotic modality. Methods: We performed a clinical outcome and safety evaluation of robotic-assisted SU compared to the traditional open approach. In this retrospective study of 53 patients (40 open, 13 robotic) treated between 2008 and 2025, we assessed perioperative, functional, and oncological parameters. Results: Regarding safety endpoints, robotic SU demonstrated a favorable profile with no significant difference in postoperative complication rates compared to open surgery (15.4% vs. 26.5%, p = 0.7). While the robotic approach involved longer operative times (351 vs. 285 min, p = 0.01), it resulted in a significantly shorter median hospital stay (4 vs. 12 days, p < 0.001). Utilizing Firth’s penalized Cox regression to account for sparse events, no significant differences were observed in overall survival (HR 1.25, 95% CI 0.13–6.17, p = 0.815) or disease-free survival (HR 1.22, 95% CI 0.31–3.63, p = 0.75). Similarly, secondary endpoints including intraluminal recurrence-free (p = 0.188), intravesical recurrence-free (p = 0.581), and metastasis-free survival (p = 0.997) did not differ significantly. Postoperatively, functional evaluation revealed a trend toward improved renal function in the robotic cohort (+ 22.94 vs. +7.46 mL/min/1.73 m², p = 0.08). Conclusions: Robotic SU appears feasible and was not associated with an apparent compromise in short-term oncological outcomes during the available follow-up period, while offering the benefits of minimally invasive recovery. Given the limited follow-up and small sample size of the robotic cohort, these results provide preliminary evidence of safety. Further multi-institutional, large-scale studies with extended follow-up are required to establish definitive long-term non-inferiority.