Single-Position Versus Traditional Retroperitoneal Laparoscopic Nephroureterectomy for UTUC: Long-Term Survival and Perioperative Outcomes

Background: 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. Methods: 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. Results: 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). Conclusion: SRLRNU is a safe and effective alternative to TRLRNU, offering improved perioperative outcomes without compromising long-term cancer control in UTUC patients.