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Abrate A, Vella M, Mogorovich A, Giaimo R, Serretta V, Pavone C, Bartoletti R, Simonato A. Time to safely omit bladder cuff removal for low-risk upper tract urothelial carcinoma. Minerva Urol Nephrol 2021; 73:417-420. [PMID: 33887892 DOI: 10.23736/s2724-6051.21.04299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alberto Abrate
- Unit of Urology, Department of Surgery, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Marco Vella
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Andrea Mogorovich
- Unit of Urology, Azienda Sanitaria Toscana Nord Ovest, Viareggio, Lucca, Italy
| | - Rosa Giaimo
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vincenzo Serretta
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Carlo Pavone
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy -
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Piszczek R, Nowak Ł, Krajewski W, Chorbińska J, Poletajew S, Moschini M, Kaliszewski K, Zdrojowy R. Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis. World J Surg Oncol 2021; 19:129. [PMID: 33882936 PMCID: PMC8061074 DOI: 10.1186/s12957-021-02236-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2021] [Indexed: 01/02/2023] Open
Abstract
Background During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU. Materials and methods The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled. Results Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60–1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62–1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85–1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94–1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter. Conclusions Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02236-z.
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Affiliation(s)
- Radosław Piszczek
- Department of Urology and Oncologic Urology, Lower Silesian Specialist Hospital, Fieldorfa 2 Street, 50-556, Wroclaw, Poland
| | - Łukasz Nowak
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland.
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Joanna Chorbińska
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Sławomir Poletajew
- Centre of Postgraduate Medical Education, Marymonecka 99/813 Street, 01-813, Warsaw, Poland
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse, 6004, 16, Lucerne, Switzerland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland
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Abstract
The cornerstone for diagnosis and treatment of bladder and upper tract urothelial carcinoma involves surgery. Transurethral resection of bladder tumors forms the basis of further management. Radical cystectomy for invasive bladder carcinoma provides good oncologic outcomes. However, it can be a morbid procedure, and advances such as minimally invasive surgery and early recovery after surgery need to be incorporated into routine practice. Diagnostic ureteroscopy for upper tract carcinoma is needed in cases of doubt after cytology and imaging studies. Low-risk cancers can be managed with conservative endoscopic surgery without compromising oncological outcomes; however, high-risk disease necessitates radical nephroureterectomy.
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Robotic radical nephro-ureterectomy for high-risk upper tract urothelial carcinoma: Step-by-step illustrative video of surgical technique. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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56
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Kanno T. Editorial Comment to Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning. Int J Urol 2020; 28:169. [PMID: 33202483 DOI: 10.1111/iju.14423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
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57
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Kenigsberg AP, Smith W, Meng X, Ghandour R, Rapoport L, Bagrodia A, Lotan Y, Woldu SL, Margulis V. Robotic Nephroureterectomy vs Laparoscopic Nephroureterectomy: Increased Utilization, Rates of Lymphadenectomy, Decreased Morbidity Robotically. J Endourol 2020; 35:312-318. [PMID: 33081512 DOI: 10.1089/end.2020.0496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective: Robotic radical nephroureterectomy (RRNU) may offer advantages over laparoscopic radical nephroureterectomy (LRNU). The purpose of this study is to evaluate the overall survival (OS) of patients with upper tract urothelial carcinoma (UTUC) who underwent RRNU vs LRNU and identify factors that account for differences. Methods: The National Cancer Database was queried from 2010 to 2016 for patients with American Joint Committee on Cancer 6th/7th edition Stage I/II/III UTUC. Kaplan-Meier analysis compared LRNU and RRNU OS. Univariate analysis detected differences between the groups. Cox regression determined factors associated with mortality rate. Logistic regression identified predictors of a lymph node dissection (LND) and 90-day mortality rate. Results: A total of 2631 patients met the criteria, 1129 of whom underwent RRNU and 1502 LRNU, with a follow-up of 33 and 35 months, respectively (p = 0.063). RRNU had a median OS of 71.1 vs 62.6 months (p = 0.033). LRNU patients were older (72.7 vs 71.4, p < 0.001) and had no differences in comorbidities, pathologic T stage, or grade. The LRNU cohort was less likely to undergo LND (19% vs 35%, p < 0.001) and had a lower median lymph node yield (3 vs 4, p < 0.001). LRNU patients more likely underwent conversion to an open procedure, had longer hospital stays, and higher 30- and 90-day mortality rates. LRNU was independently associated with mortality rate (p = 0.030). Age, grade, positive margins, pT/pN stage were associated with mortality rate. Younger age, RRNU, surgery at an academic center, and neoadjuvant chemotherapy predicted an LND. Conclusions: RRNU demonstrated increased rates of LND and may offer a short-term morbidity benefit to LRNU. Survival differences may be due to improved characterization of disease through LND.
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Affiliation(s)
- Alexander P Kenigsberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wesley Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Seisen T, Mari A, Campi R, Peyronnet B, Bensalah K, Rioux-Leclercq N, Pfister C, Gobet F, De La Taille A, Allory Y, Xylinas E, Neuzillet Y, Radulescu C, Descotes JL, Saada-Sebag G, Irani J, Delpech-Debiais C, Bigot P, Eymerit C, Crouzet S, Mege-Lechevallier F, Ruffion A, Decaussin-Petrucci M, Droupy S, Roger P, Durand X, Camparo P, Cussenot O, Compérat E, Rouprêt M. Prognostic Impact of pT3 Subclassification in a Multicentre Cohort of Patients with Urothelial Carcinoma of the Renal Pelvicalyceal System Undergoing Radical Nephroureterectomy: A Propensity Score-weighted Analysis After Central Pathology Review. Eur Urol Focus 2020; 7:1075-1083. [PMID: 33463527 DOI: 10.1016/j.euf.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current pathological tumour-node-metastasis (pTNM) classification for upper tract urothelial carcinoma (UTUC) does not include any risk stratification of pT3 renal pelvicalyceal tumours. OBJECTIVE To assess the prognostic impact of pT3 subclassification in a multicentre cohort of patients with UTUC of the renal pelvicalyceal system undergoing radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS Data from all consecutive patients treated with RNU for pT3 renal pelvicalyceal UTUC at 14 French centres from 1995 to 2013 were reviewed retrospectively. INTERVENTION A central pathology review (CPR) was used to stratify pT3 patients into those with infiltration of the renal parenchyma on a microscopic level (pT3a) versus those with infiltration of the renal parenchyma visible on gross inspection of the resection specimen and/or invasion of peripelvic fat (pT3b). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Inverse probability weighting (IPW)-adjusted Cox regression analyses were used to compare recurrence-free survival (RFS) and cancer-specific survival (CSS) between pT3a and pT3b patients. RESULTS AND LIMITATIONS Overall, 202 patients were included and further stratified into pT3a (n = 98; 48.5%) and pT3b (n = 104; 51.5%) subgroups. Median time to follow-up in the weighted population was 68 (interquartile range, 50-95) mo. In IPW-adjusted Cox regression analyses, pT3b versus pT3a substage was associated with a significant adverse effect on RFS (hazard ratio [HR] = 2.02; 95% confidence interval [CI] = [1.36-3.01]; p < 0.001) and CSS (HR = 1.84; 95% CI = [1.20-2.82]; p = 0.005). The study is limited by its retrospective design. CONCLUSIONS Using IPW-adjusted analyses after the CPR, we observed that RNU patients with pT3b renal pelvicalyceal UTUC had adverse prognosis as compared with those with pT3a disease. As such, this subclassification could help refine the current pTNM system for UTUC. PATIENT SUMMARY In this report, we looked at the prognostic interest of stratifying patients with pT3 renal pelvicalyceal upper tract urothelial carcinoma based on the extent of local invasion. We found that those with extensive infiltration (pT3b) had adverse prognosis as compared with those with limited infiltration (pT3a). This information could be provided on pathology reports to further guide clinical decision making.
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Affiliation(s)
- Thomas Seisen
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | | | - Françoise Gobet
- Department of Pathology, Rouen University Hospital, Rouen, France
| | | | - Yves Allory
- Department of Pathology, Henri Mondor Hospital, Créteil, France
| | | | | | | | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Jacques Irani
- Department of Urology, Poitier University Hospital, Poitier, France
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
| | - Caroline Eymerit
- Department of Pathology, Angers University Hospital, Angers, France
| | | | | | - Alain Ruffion
- Department of Urology, Lyon Sud University Hospital, Pierre Bénite, France
| | | | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Pascal Roger
- Department of Pathology, Nîmes University Hospital, Nîmes, France
| | - Xavier Durand
- Department of Urology, Val-de-Grâce Hospital, Paris, France
| | | | | | - Eva Compérat
- Department of Pathology, Tenon Hospital, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France.
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59
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Alothman KI, Mehmood S, Alzahrani HM, Alotaibi MF, Alkhudair WK, Eldali AM. Surgical and oncological outcome after laparoscopic versus open nephroureterectomy for non-metastatic, upper-tract urothelial carcinoma. A single-centre experience. Saudi Med J 2020; 41:25-33. [PMID: 31915791 PMCID: PMC7001069 DOI: 10.15537/smj.2020.1.24780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: We determined the surgical and oncological outcomes of laparoscopic nephroureterectomy (LNU) in comparison to open nephroureterectomy (ONU) and factors predicting bladder recurrence after nephroureterectomy. Methods: We retrospectively reviewed and compared the data of patients who underwent ONU or LNU for non-metastatic, upper-tract urothelial carcinoma from 2000 to 2016. The primary endpoint was to determine bladder cancer recurrence-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). The data were analysed using Student’s t-test, Chi-square test, and Kaplan-Meier curve. Results: Total of 50 patients, of which 24 had LNU and 26 had ONU, met the inclusion criteria. Median durations of follow-up were 4.2 and 6.5 years (p=0.1070) in LNU and ONU, respectively. Operative time, blood loss and hospital stay were significantly lower in the LNU group than in the ONU group (p=0.0001, p=0.0001, p=0.0018). Cancer-specific survival rate in the LNU was 75% and ONU was 73.3% (p=0.1902), whereas BCRFS and CSS were not significantly different in both groups (log-rank test; BCRFS: p=0.809 and CSS: p=0.802). Patients who underwent ureteroscopy with biopsy (p=0.001), had multifocality (p=0.001) and previous history of (H/O) bladder cancer (p=0.020) were at significant risk for developing bladder cancer recurrence after nephroureterectomy. Conclusion: Laparoscopic nephroureterectomy can benefit patients because of its minimal invasiveness, and oncologic outcomes are comparable to ONU. Preoperative ureteroscopy with biopsy, multifocality and previous H/O bladder cancer might be risk factors for bladder cancer recurrence.
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Affiliation(s)
- Khalid I Alothman
- Department of Urology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Moschini M, Zamboni S, Afferi L, Pradere B, Abufaraj M, Soria F, D'Andrea D, Roupret M, De la Taille A, Simeone C, Mattei A, Mathieu R, Bensalah K, Wirth MP, Montorsi F, Briganti A, Gallina A, Simone G, Gallucci M, Di Bona C, Marra G, Mari A, Di Trapani E, Alvarez Maestro M, Krajewski W, Shariat SF, Xylinas E, Baumeister P. Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A propensity score-matched analysis. Arab J Urol 2020; 19:31-36. [PMID: 33763246 PMCID: PMC7954493 DOI: 10.1080/2090598x.2020.1817720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objectives To compare oncological outcomes of open (ORNU) and laparoscopic radical nephroureterectomy (LRNU) after controlling for preoperative patient-derived factors. Patients and methods We evaluated a multi-institutional collaborative database composed of 3984 patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with RNU between 2006 and 2018. To adjust for potential selection bias, propensity score matching adjusted for age, gender and American society Anesthesiology (ASA) score was performed with one ORNU patient matched to one LRNU patient. Uni- and multivariable Cox regression evaluating the risk of overall recurrence, cancer-specific mortality (CSM) and overall mortality (OM) in the overall population and after propensity matching were performed. Results In total, 3984 patients underwent RNU, of these 3227 (81%) patients were treated with ORNU and 757 (19%) patients with LRNU. Within a median follow-up of 62 months, 1276 recurrences, 844 CSMs and 1128 OMs were recorded. On multivariable analyses, the LRNU approach was associated with an increased risk of overall recurrence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.03–1.54; P = 0.02), but on the other hand LRNU was associated with a protective effect on CSM (HR 0.74, 95% CI 0.56–0.98; P = 0.04). After propensity matching analyses adjusted for age, gender and ASA score, 757 patients treated with LRNU and 757 patients treated with ORNU were available for the analyses. On multivariable Cox regression, LRNU vs ORNU was not associated with any difference in overall recurrence (P = 0.08), CSM (P = 0.1) or OM (P = 0.9). Conclusion Our present data suggest that even if the type of approach to RNU was associated with different survival outcomes considering the overall population, this difference vanished when adjusted for potential confounders in propensity matching analyses. Therefore, we found that LRNU is not inferior to the ORNU approach for the treatment of UTUC. Abbreviations ASA: American Society of Anesthesiology; CIS: carcinoma in situ; CSM: cancer-specific mortality; HR: hazard ratio; IQR: interquartile range; LN: lymph node; LNI: lymph node invasion; LVI: lymphovascular invasion; OM: overall mortality; pT: pathological tumour stage; RCT: randomised controlled trial; (L)(O)RNU: (laparoscopic) (open) radical nephroureterectomy; UTUC: upper tract urothelial carcinoma
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Affiliation(s)
- Marco Moschini
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefania Zamboni
- Urology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Benjamin Pradere
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France
| | - Mohammad Abufaraj
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, the University of Jordan, Amman, Jordan
| | - Francesco Soria
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - David D'Andrea
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Morgan Roupret
- Urology, Assistance Publique-Hôpitaux De Paris (AP-HP), Sorbonne University, Hopital Pitié Salpétrière, Paris, France
| | - Alexandre De la Taille
- Department of Urology, Assistance Publique-Hôpitaux De Paris (AP-HP) CHU Mondor, Faculté De Médecine, Henri Mondor Hospital, Créteil, France
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Romain Mathieu
- Urology, Rennes University Hospital (France), Rennes, France
| | - Karim Bensalah
- Urology, Rennes University Hospital (France), Rennes, France
| | - Manfred Peter Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Simone
- Department of Urology, 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Carlo Di Bona
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | | | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Shahrokh F Shariat
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Motol Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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Shigeta K, Matsumoto K, Takeda T, Hattori S, Kaneko G, Matsushima M, Abe T, Tanaka N, Mizuno R, Asanuma H, Kikuchi E, Oya M. Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching. Ann Surg Oncol 2020; 28:465-473. [PMID: 32840743 DOI: 10.1245/s10434-020-09046-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. METHODS Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes. RESULTS Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR. CONCLUSION Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Hattori
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Gou Kaneko
- Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Takayuki Abe
- Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Shigeta K, Matsumoto K, Oya M. ASO Author Reflections: Discussing the Oncological Feasibility of Performing Pure Laparoscopic Radical Nephroureterectomy for Upper-Tract Urothelial Carcinoma Patients: Results from a Multi-institution Collaborative Study Adjusted by Propensity Score Matching. Ann Surg Oncol 2020; 28:474-475. [PMID: 32813203 DOI: 10.1245/s10434-020-09048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Kondo T. Editorial Comment to "Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching". Ann Surg Oncol 2020; 28:27-28. [PMID: 32812110 DOI: 10.1245/s10434-020-09050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
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Song L, Wang W, Zhao Q, Wen Y, Zhou X, Han H, Zhang X. A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes. Cancer Manag Res 2020; 12:5721-5728. [PMID: 32765075 PMCID: PMC7369369 DOI: 10.2147/cmar.s259964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes. Methods From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient’s characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results LNU was performed successfully on all 106 patients. There was no significant difference in patients’ characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P<0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P<0.001). Conclusion The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.
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Affiliation(s)
- Liming Song
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenkuan Wang
- Department of Urology, Beijing Haidian Hospital/Haidian Hospital of Beijing University Third Hospital, Beijing, People's Republic of China
| | - Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuhong Wen
- Department of Urology, Huhehaote First Hospital, Inner Mongolia, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hu Han
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaodong Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Gulamhusein A, Silva P, Cullen D, Tran M, Mumtaz F, Patki P, Barod R, Bex A. Safety and feasibility of early single‐dose mitomycin C bladder instillation after robot‐assisted radical nephroureterectomy. BJU Int 2020; 126:739-744. [DOI: 10.1111/bju.15162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Aziz Gulamhusein
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Pedro Silva
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - David Cullen
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Maxine Tran
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
| | - Axel Bex
- Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK
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66
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Kenigsberg AP, Meng X, Ghandour R, Margulis V. Oncologic outcomes of radical nephroureterectomy (RNU). Transl Androl Urol 2020; 9:1841-1852. [PMID: 32944548 PMCID: PMC7475687 DOI: 10.21037/tau.2019.12.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Radical nephroureterectomy is the mainstay of surgical treatment for upper tract urothelial carcinoma (UTUC), a disease which comprises approximately 5% of urothelial malignancies. Minimally-invasive and nephron-sparing interventions have been explored, although thus far have not shown comparable oncologic outcomes except in a relatively narrow set of patients. Due to the relative rarity of the disease, it has taken decades and multi-disciplinary efforts to sufficiently identify prognostic factors of oncologic outcomes. Despite these efforts, however, oncologic outcomes of nephroureterectomy have remained remarkably stable over the past 30 years. New techniques, such as laparoscopic and robotic surgery, have been applied to this procedure. High level evidence regarding equivalent oncologic outcomes is lacking and open surgery remains the standard of care for high-stage disease, although there is a role for laparoscopic and robotic nephroureterectomy. The importance of bladder cuff removal in improving oncologic outcomes has been broadly accepted, although there is no consensus as to the most oncologically appropriate technique. There does appear to be evidence that endoscopic techniques confer worse oncologic control. The role of lymphadenectomy remains controversial, although there is evidence that increased nodal yield could have oncologic benefit. Given disease heterogeneity and varied technical approaches to the procedure, no consensus standardized template has been identified. There is level 1 evidence for the use of intravesical chemotherapy peri-operatively and that this intervention can improve the risk of intravesical recurrence. Advances in systemic neoadjuvant and adjuvant chemotherapy have yielded promising results and are likely to become standard of care for patients without contraindications. Immunotherapy and targeted biologic agents are also likely to improve the surgical efficacy of radical nephroureterectomy as well. Ultimately, more high level evidence is needed to identify successful surgical and medical approaches to UTUC and multi-institutional collaboration is critical to this progress.
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Affiliation(s)
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Lonergan PE, Porten SP. Bladder tumor recurrence after urothelial carcinoma of the upper urinary tract. Transl Androl Urol 2020; 9:1891-1896. [PMID: 32944553 PMCID: PMC7475654 DOI: 10.21037/tau.2020.03.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a relatively uncommon and poorly investigated malignancy, however, bladder recurrence after radical nephroureterectomy (RNU) is a frequent event. In this review, we summarize the current knowledge on risk prediction of bladder tumor recurrence after RNU, including surgical strategies and adjuvant intravesical treatments to reduce the risk of recurrence. Finally, we outline some of the more recent advances in genomics that will likely lead to new prognostic markers and risk stratification tools that may refine UTUC treatment in the future.
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Affiliation(s)
- Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Sima P Porten
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
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European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol 2020; 79:62-79. [PMID: 32593530 DOI: 10.1016/j.eururo.2020.05.042] [Citation(s) in RCA: 480] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract carcinoma, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, adjuvant treatment, instillation, recurrence, risk factors, and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification as well as for radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumour and two functional kidneys. After radical nephroureterectomy, cisplatin-based chemotherapy is indicated in locally advanced UTUC. CONCLUSIONS These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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69
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Pathak RA, Hemal AK. Fate of residual ureteral stump in patients undergoing robot-assisted radical nephroureterectomy for high-risk upper tract urothelial carcinoma. Transl Androl Urol 2020; 9:856-862. [PMID: 32420200 PMCID: PMC7214963 DOI: 10.21037/tau.2019.09.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Management of the distal ureter in radical nephroureterectomy and bladder cuff excision (RNUBCE) is paramount, directly influencing oncologic outcomes. Herein, we analyze the natural history of patients who have undergone robotic radical nephroureterectomy without formal bladder cuff excision and retained ureteral stump and compare this cohort with patients undergoing formal RNUBCE for high-risk upper tract urothelial carcinoma (UTUC). Methods From February 2008 to October 2018, all patients who underwent robotic RNUBCE by multiple surgeons in a single institution for high-risk UTUC were reviewed. Preoperative, perioperative, and postoperative variables were investigated. Overall survival, cancer specific survival, local recurrence-free survival, distant recurrence-free survival, and bladder recurrence-free survival were compared between the two cohorts. Further management treatments were explored for patients with retained ureteral stump. Follow-up consisted of abdominopelvic/chest imaging and cystoscopy at regular intervals. Results A total of 105 patients underwent robotic RNU during the above time period. Of patients with documented 6-month follow-up, approximately 6.6% of patients had retained ureteral stump. Median follow-up for the entire cohort was 31.5 months with a range of 6 to 114.2 months. Factors that precluded formal BCE were densely, fibrotic reaction near the ureterovesical junction due to prior vascular or pelvic surgery in 5 patients, severe pyonephrosis and continued anesthetic risk in one patient, and surgeon choice (patient co-morbidities) in another patient. Three patients died with metastatic disease and one patient succumbed to cardiovascular compromise. Two additional patients developed local recurrence only at the level of the ureteral stump, with one patient undergoing eventual distal excision, contralateral RNUBCE and radical cystectomy. Conclusions In these cases, responsibilities assumed by the surgeon demand the utmost in judgement and skill; however, at times, circumstances prevail such as patient factors and nature/biology of the disease. These factors may prevent adequate excision the complete ureter, ureterovesical junction, and bladder cuff at the time of RNU. In this robotic cohort of patients undergoing RNUBCE for UTUC, not excising the most distal part of the ureter directly translates to inferior oncologic outcomes. Complete ureteral excision with bladder cuff should be performed where possible as this is an integral part of the radical nephroureterectomy. Also, if feasible, adjunctive chemotherapy/immunotherapy treatments should be considered.
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Affiliation(s)
- Ram A Pathak
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
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Wu Z, Li M, Wang J, Veccia A, Xu Y, Zhang C, Ren J, Yin L, Chen M, Wang J, Xu D, Zhang Z, Liu B, Yang B, Xie L, Qu L, Wang L. Pure retroperitoneoscopic extravesical standardized seeable (PRESS) excision of distal ureter and bladder cuff in radical nephroureterectomy: step-by-step technique. Minerva Urol Nephrol 2020; 73:392-400. [PMID: 32284528 DOI: 10.23736/s2724-6051.20.03711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concerns have been raised regarding the management of bladder cuff with these minimally invasive approaches. The aim of this study was to describe a modified radical nephroureterectomy (RNU) with pure retroperitoneoscopic extravesical standardized seeable (PRESS) bladder cuff excision (BCE) and to assess its outcomes based on a novel concept of intraoperative "trifecta." METHODS Twenty-four patients with upper urinary tract urothelial carcinoma underwent retroperitoneoscopic RNU from August 2017 to August 2019. A modified RNU with PRESS BCE and lymph node dissection (LND) was performed. Descriptive analysis of patients' characteristics, surgical technique, perioperative outcomes, and follow-up data was performed. BCE trifecta was defined as en-bloc excision, mucosa-to-mucosa reliable closure and no urine spillage. RESULTS In 23 out of 24 cases (95.8%) the procedure was successfully completed. One patient was converted to open distal ureterectomy with a Gibson incision due to peritoneum rupture during dissection of the distal ureter. BCE trifecta was achieved in 95.7% (22/23) cases of all patients finished with PRESS technique. Median OT was 260 min (IQR: 220-305) with median EBL of 100 mL (IQR: 100-250). Median OT for distal ureterectomy was 52 min (IQR: 40-69). No positive surgical margin occurred. Median postoperative hospital stay was 6 d (IQR: 5-7). Median follow-up time was 7 mo (IQR: 5-17). One patient (4.3%) experienced bladder recurrence and no patient developed distant metastasis or died of the disease. CONCLUSIONS Herein, we demonstrate a standardized retroperitoneoscopic RNU technique that is safe and reproducible, enabling the visual confirmation of complete BCE and facilitating LND. BCE trifecta should be a routine goal in minimally invasive RNU. Prospective comparison with the standard open surgical technique is warranted.
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Affiliation(s)
- Zhenjie Wu
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Mingmin Li
- Department of Radiology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Jianchao Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA.,Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili Hospital, University of Brescia, Italy
| | - Yifan Xu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Jizhong Ren
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Lei Yin
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Ming Chen
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Junkai Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Dongliang Xu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Zongqin Zhang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China -
| | - Le Qu
- Department of Urology, East Region Military Command General Hospital (Jinling Hospital), Clinical School of Medical College, Nanjing University, Nanjing, China
| | - Linhui Wang
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
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Baard J, Celebi M, de la Rosette J, Alcaraz A, Shariat S, Cormio L, Cavadas V, Laguna MP. Evaluation of Patterns of Presentation, Practice, and Outcomes of Upper Tract Urothelial Cancer: Protocol for an Observational, International, Multicenter, Cohort Study by the Clinical Research Office of the Endourology Society. JMIR Res Protoc 2020; 9:e15363. [PMID: 32012106 PMCID: PMC7007587 DOI: 10.2196/15363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Available guidelines on the management of upper tract urothelial carcinoma (UTUC) are restricted due to the lack of strong evidence-based recommendations. Adequate, well-powered randomized trials are missing due to the rarity of the disease. To overcome this problem, we need alternative study designs to provide generalizable data. OBJECTIVE The primary aim of this registry is to provide a real-world overview on patterns of presentation and management of UTUC. Secondary objectives include comparison of outcomes of different treatments and tumor stages and evaluation of compliance with the current European Association of Urology recommendations for UTUC. METHODS For this observational, international, multicenter, cohort study, clinical data of consecutive patients suspected of having UTUC, irrespective of type of management, will be prospectively collected up to 5 years after inclusion. Data on the patterns of presentation, diagnostics, and treatment as well as short-, mid-, and long-term oncological and functional outcomes will be analyzed. Possible associations between variables, basal characteristics, and outcomes will be tested by multivariable analyses. The methodology will address potential sources of bias and confounders. RESULTS The registry was initiated in November 2014 after obtaining institutional review board approval. Data collection started in December 2014. At the time of submission of this manuscript, 2451 patients from 125 centers from 37 countries were included. Inclusion of patients will be closed 5 years after initiation of the registry. Quality checks will be performed centrally with continuous communication and feedback with the centers to ensure accuracy. The first results are expected in the first trimester of 2020. CONCLUSIONS This large observational prospective cohort will generate landmark "real-world" data and hypotheses for further studies. We expect these data to optimize the management of UTUC, provide insights on harms and benefits of treatment, and serve as quality control. TRIAL REGISTRATION ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15363.
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Affiliation(s)
- Joyce Baard
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Shahrokh Shariat
- Medical University of Vienna, Vienna, Austria
- University of Texas Southwestern, Dallas, TX, United States
- Motol Hospital Charles University, Prague, Czech Republic
- IM Sechenov University, Moscow, Russian Federation
| | | | - Vítor Cavadas
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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Azawi NH, Næraa SH, Subhi Y, Vásquez JL, Norus T, Dahl C, Thind P, Jensen JB. Oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in Denmark. Scand J Urol 2020; 54:58-64. [PMID: 31942812 DOI: 10.1080/21681805.2019.1710562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large study sample.Materials and methods: This was a nationwide multicenter registry-based cohort study of all patients with upper urinary tract urothelial neoplasia in Denmark found to be eligible for nephroureterectomy between April 2004 and April 2017 (N = 1384). Primary endpoints were intravesical recurrence-free survival and overall survival. Survival probabilities were estimated with Kaplan-Meier and the log-rank test to compare survival curves. Association with clinical outcomes was studied using univariate and multivariate Cox proportional hazards.Results: Intravesical recurrence-free survival was 72% [95% confidence interval (CI) 69-75%] at 5 years and 70% (95% CI 67-73%) at 10 years. Patients with muscle-invasive disease had a significantly lower rate of intravesical recurrence [hazard ratio (HR) = 0.46, p < 0.0001] and patients with high-grade tumors had a significantly higher rate of incident intravesical recurrence compared to low-grade tumors (HR = 1.65, p = 0.001). The overall survival was 76% (95% CI 74-79%) at 5 years and 64% (95% CI 60-70%) at 10 years. Patients with higher age (p = 0.008) and muscle-invasive disease (p < 0.0001) had worse overall survival. When comparing surgical approaches, laparoscopic nephroureterectomy versus open nephroureterectomy did not differ in intravesical recurrence-free survival but was associated with shorter postoperative hospital stay (p < 0.0001) and better overall survival (p = 0.02).Conclusions: We report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large sample and give insights into predictive factors with significant impact.
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Affiliation(s)
- Nessn H Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Yousif Subhi
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Juan Luis Vásquez
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Thomas Norus
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Claus Dahl
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Peter Thind
- Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Regionshospitalet Holstebro, Holstebro, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Leow JJ, Liu Z, Tan TW, Lee YM, Yeo EK, Chong YL. Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives. Onco Targets Ther 2020; 13:1-15. [PMID: 32021250 PMCID: PMC6954076 DOI: 10.2147/ott.s225301] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/12/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Upper tract urothelial carcinoma (UTUC) is a relatively uncommon urologic malignancy for which there has not been significant improvement in survival over the past few decades, highlighting the need for optimal multi-modality management. METHODS A non-systematic review of the latest literature was performed to include relevant articles up to June 2019. It summarizes the epidemiologic risk factors associated with UTUC, including smoking, carcinogenic aromatic amines, arsenic, aristolochic acid, and Lynch syndrome. Molecular pathways underlying UTUC and potential druggable targets are outlined. RESULTS Surgical management for UTUC includes kidney-sparing surgery (KSS) for low-risk disease and radical nephroureterectomy (RNU) for high-risk disease. Endoscopic management of UTUC may include ureteroscopic or percutaneous resection. Topical instillation therapy post-KSS aims to reduce recurrence, progression and to treat carcinoma-in-situ; this may be achieved retrogradely (via ureteric catheterization), antegradely (via percutaneous nephrostomy) or via reflux through double-J stent. RNU, which may be performed via open, laparoscopic or robot-assisted approaches, is the gold standard treatment for high-risk UTUC. The distal cuff may be dealt with extravesical, transvesical or endoscopic techniques. Peri-operative chemotherapy and immunotherapy are increasingly utilized; level 1 evidence exists for adjuvant chemotherapy, but neoadjuvant chemotherapy is favored as kidney function is better prior to RNU. Immunotherapy is primarily reserved for metastatic UTUC but is currently being investigated in the perioperative setting. CONCLUSION The optimal management of UTUC includes a firm understanding of the epidemiological factors and molecular pathways. Surgical management includes KSS for low-risk disease and RNU for high-risk disease. Peri-operative immunotherapy and chemotherapy may be considered as evidence mounts.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zhenbang Liu
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Surgery, Woodlands Health Campus, Singapore
| | - Teck Wei Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yee Mun Lee
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Eu Kiang Yeo
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yew-Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Oliveira C, Barros AA, Reis RL, Correia-Pinto J, Lima E. New endoscopic procedure for bladder wall closure: results from the porcine model. Sci Rep 2019; 9:18747. [PMID: 31822690 PMCID: PMC6904675 DOI: 10.1038/s41598-019-54304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022] Open
Abstract
Upper urinary tract urothelial carcinomas are usually managed by radical nephroureterectomy (RNU), often followed by intravesical chemotherapy to minimize recurrence. Open surgery is the gold standard procedure for RNU, but it associates with high morbidity, and it has been increasingly replaced by minimally invasive strategies, such as laparoscopy and endoscopy. Although effective, endoscopic ureteral excision leaves the bladder unsutured, increasing the risk of tumor spillage, and precluding the immediate administration of intravesical chemotherapy. Here we describe a new method to close the bladder wall after ureteral excision, using barbed sutures via the endoscopic access. Our results in 8 female pigs demonstrate that this method is effective to close the bladder wall. The procedure was completed in a median time of 24 min, and no adverse events were registered in the follow-up or at the three-week necropsy. This technique improves a previous approach described by our group because the device is more flexible and allows to tie the knots inside the bladder. Barbed sutures have been used in the clinical practice for other types of surgeries, and therefore this method can further be adapted to human patients with no safety concerns. Its use may allow to administer intravesical chemotherapy, which reduces tumor recurrence and improves patient outcomes.
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Affiliation(s)
- Carlos Oliveira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal. .,ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal. .,Department of Urology, Hospital de Braga, Braga, Portugal. .,3B´s Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark - Parque de Ciência e Tecnologia, 4805-017, Barco, GMR, Portugal.
| | - Alexandre A Barros
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.,3B´s Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark - Parque de Ciência e Tecnologia, 4805-017, Barco, GMR, Portugal
| | - Rui L Reis
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.,3B´s Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark - Parque de Ciência e Tecnologia, 4805-017, Barco, GMR, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Estêvão Lima
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.,Department of Urology, Hospital de Braga, Braga, Portugal
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75
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Taylor J, Meng X, Ghandour R, Margulis V. Advancements in the clinical management of upper tract urothelial carcinoma. Expert Rev Anticancer Ther 2019; 19:1051-1060. [PMID: 31770492 DOI: 10.1080/14737140.2019.1698295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Upper tract urothelial carcinoma (UTUC) remains a complex disease to manage given challenges in staging, surgical resection, use of perioperative therapy, and prevention of bladder recurrences. High-level evidence is limited to guide management; however, recent data have shifted treatment paradigms. We intend to review recent evidence on advancements in the clinical management for UTUC.Areas covered: This review summarizes advancements in pre-operative work-up, surgical technique, and the use of intravesical and systemic therapy in both the neoadjuvant and adjuvant settings. Special comment is made on progress in the genomics of UTUC and how that can inform clinical practice.Expert opinion: Advancements in the clinical management of UTUC are most prominently being made in the neoadjuvant chemotherapy setting. Although level I evidence is sparse, data from both single and multi-institutional retrospective studies strongly encourage the use of neoadjuvant chemotherapy especially in high-risk or advanced-stage patients.
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Affiliation(s)
- Jacob Taylor
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rashed Ghandour
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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76
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Veccia A, Antonelli A, Francavilla S, Simeone C, Guruli G, Zargar H, Perdoná S, Ferro M, Carrieri G, Hampton LJ, Porpiglia F, Autorino R. Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases. World J Urol 2019; 38:845-852. [PMID: 31773242 DOI: 10.1007/s00345-019-03020-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. METHODS A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. RESULTS Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI - 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. CONCLUSIONS Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.,Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Simone Francavilla
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Georgi Guruli
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | - Homayoun Zargar
- Department of Surgery, Department of Urology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Sisto Perdoná
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | | | - Riccardo Autorino
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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Shigeta K, Kikuchi E, Abe T, Hagiwara M, Ogihara K, Anno T, Umeda K, Baba Y, Sanjo T, Shojo K, Mizuno R, Oya M. Long-Term Oncologic Outcomes of Laparoscopic Versus Open Radical Nephroureterectomy for Patients with T3N0M0 Upper Tract Urothelial Carcinoma: A Multicenter Cohort Study with Adjustment by Propensity Score Matching. Ann Surg Oncol 2019; 26:3774-3781. [PMID: 31313043 DOI: 10.1245/s10434-019-07623-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to investigate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) for patients with clinical and pathologic T3N0M0 upper tract urothelial carcinoma (UTUC). METHODS Among 375 UTUC patients who underwent radical nephroureterectomy, this study identified 144 pT3N0M0 patients as cohort 1 after propensity score (PS) matching. Among 399 UTUC patients, the study identified 110 cT3N0M0 patients as cohort 2 after PS matching. Oncologic outcomes such as intravesical recurrence-free survival (IVRFS) and cancer-specific survival (CSS) were assessed by multivariate Cox's regression analysis. RESULTS Cohort 1 of pT3N0M0 UTUC had 3-year CSS and IVRFS rates of 67.9 and 52.7%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (81.4%, p = 0.039 and 71.6%, p = 0.046). The multivariate Cox's regression analysis identified the type of surgical approach (LRNU vs. ORNU) as one of the independent prognostic factors for CSS (hazard rate [HR], 1.88, p = 0.043) and IVRFS (HR, 1.75, p = 0.049). Cohort 2 of cT3N0M0 UTUC had 3-year CSS and IVRFS rates of 48.5 and 41.4%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (65.8%, p = 0.049 and 67.2%, p = 0.047), and the type of surgical approach (LRNU vs. ORNU) remained as one of the independent prognostic factors for CSS and IVRFS. CONCLUSIONS Based on clinical and pathologic T3N0M0 UTUC populations after PS adjustments, LRNU resulted in poorer CSS and IVRFS than ORNU.
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Takayuki Abe
- Department of Preventive Medicine and Public Health, Biostatistics Unit at the Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Hagiwara
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Koichiro Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tadanori Anno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, Saitama City Hospital, Saitama, Japan.,Department of Urology, Saitama Medical Hospital, Saitama, Japan
| | - Kota Umeda
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Yuto Baba
- Department of Urology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Tansei Sanjo
- Department of Urology, Isehara Kyodo Hospital, Kanagawa, Japan
| | - Kazunori Shojo
- Department of Urology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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78
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Kim SH, Song MK, Hong B, Kang SH, Jeong BC, Ku JH, Seo HK. Developing a prediction model for disease-free survival from upper urinary tract urothelial carcinoma in the Korean population. Cancer Med 2019; 8:4967-4975. [PMID: 31283107 PMCID: PMC6718545 DOI: 10.1002/cam4.2382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background In this study, we aimed to propose a validated prediction model for disease‐free survival (DFS) after radical nephroureterectomy (RNU) in a Korean population with upper urinary tract urothelial carcinoma (UTUC). Methods We performed a retrospective review of 1561 cases of UTUC who underwent either open RNU (ONU, n = 906) or laparoscopic RNU (LNU, n = 615) from five tertiary Korean institutions between January 2000 and December 2012. Data were used to develop a prediction model using the Cox proportional hazards model. Prognostic factors were selected using the backward variable selection method. The prediction model performance was investigated using Harrell's concordance index (C‐index) and Hosmer‐Lemeshow type 2 statistics. Internal validation was performed using a bootstrap approach, and the National Cancer Center data set (n = 128) was used for external validation. Results A best‐fitting prediction model with seven significant factors was developed. The C‐index and two Hosmer‐Lemeshow type statistics of the prediction model were 0.785 (95% CI, 0.755‐0.815), 4.810 (P = 0.8506), and 5.285 (P = 0.8088). The optimism‐corrected estimate through the internal validation was 0.774 (95% CI, 0.744‐0.804) and the optimism‐corrected calibration curve was close to the ideal line with mean absolute error = 0.012. In external validation, the discrimination was 0.657 (95% CI, 0.560‐0.755) and the two calibration statistics were 0.790 (P = 0.9397) and 3.103 (P = 0.5408), respectively. Conclusion A validated prediction model based on a large Korean RNU cohort was developed with acceptable performance to estimate DFS in patients with UTUC.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Urologic Cancer Center, National Cancer Center, Goyang, Korea
| | - Mi Kyung Song
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ja Hyun Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Kyung Seo
- Department of Urology, Urologic Cancer Center, National Cancer Center, Goyang, Korea
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79
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Jung H, Giusti G, Fajkovic H, Herrmann T, Jones R, Straub M, Baard J, Osther PJS, Brehmer M. Consultation on UTUC, Stockholm 2018: aspects of treatment. World J Urol 2019; 37:2279-2287. [PMID: 31123852 PMCID: PMC6825640 DOI: 10.1007/s00345-019-02811-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/17/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose To provide an overview of treatment modalities for management of upper tract urothelial carcinoma (UTUC). Methods In accordance with the standards for a scoping review, data presentation and discussion at the Consultation on UTUC in Stockholm, 6–7 September 2018, consensus was reached on the latest and most important treatment recommendations for UTUC. Using Pubmed, Web of Science, and Embase, publications were selected based on quality, clinical relevance, and level of evidence. Results Kidney-sparing surgery should be attempted for low-grade UTUC. Radical nephroureterectomy with bladder cuff excision is first option for high-grade disease. Post-operative bladder instillation of chemotherapy should be offered after RNU to reduce intravesical recurrence rate. Identification of tumor grade and stage is crucial when selecting treatment. Ureteroscopic management of low-grade and non-invasive UTUC achieves disease-free survival similar to that offered by radical nephroureterectomy but seems to be a risk factor for intravesical recurrence. Lymphadenectomy appears important for high-risk disease, although the therapeutic benefit needs further validation. There is little evidence supporting use of Bacillus Calmette–Guérin (BCG) and mitomycin C as monotherapy and adjuvant treatment in UTUC. A randomized clinical trial has indicated that platin-based chemotherapy for invasive UTUC improves disease-free survival, suggesting that adjuvant chemotherapy should be considered standard care for ≥ T2 N0–3M0 disease. Conclusions Risk stratification assessment is feasible and mandatory in UTUC. Identification of tumor grade and stage is essential for optimal treatment selection. Kidney-sparing surgery should be offered in low-risk disease, whereas radical nephroureterectomy and adjuvant chemotherapy should be considered in high-risk disease.
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Affiliation(s)
- Helene Jung
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Robert Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland UK
| | - Michael Straub
- Department of Urology, University Hospital Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Palle Jörn Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden
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80
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Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol 2019; 37:2303-2311. [PMID: 31062121 DOI: 10.1007/s00345-019-02790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). METHODS Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. RESULTS 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was - 1 ml/min/1.73 m2 after SU and - 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. CONCLUSION Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.
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81
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Hasan MN, Rouprêt M, Keeley F, Cracco C, Jones R, Straub M, Traxer O, Osther PJS, Brehmer M. Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up. World J Urol 2019; 37:2289-2296. [PMID: 30944969 PMCID: PMC6825637 DOI: 10.1007/s00345-019-02739-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/23/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. Methods A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. Results To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). Conclusion KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
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Affiliation(s)
- Mudhar N Hasan
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Francis Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, England, UK
| | - Cecilia Cracco
- Department of Urology, Cottolengo Hospital of Torino, Torino, Italy
| | - Robert Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Michael Straub
- Department of Urology, University Hospital Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
| | | | | | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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Nazzani S, Bazinet A, Preisser F, Mazzone E, Tian Z, Mistretta FA, Shariat SF, Saad F, Zorn KC, Montanari E, Briganti A, Carmignani L, Karakiewicz PI. Comparison of perioperative outcomes between open and minimally invasive nephroureterectomy: A population‐based analysis. Int J Urol 2019; 26:487-492. [DOI: 10.1111/iju.13916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
- Academic Department of Urology IRCCS Policlinico San Donato University of Milan Milan Italy
| | - Amélie Bazinet
- Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
- Martini‐Klinik Prostate Cancer Center University Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
- Division of Oncology/Unit of Urology URI IRCCS Ospedale San Raffaele Vita‐Salute San Raffaele University Milan Italy
| | - Zhe Tian
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
| | | | | | - Fred Saad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
- Centre Hospitalier de l'Université de Montréal Center Montreal Quebec Canada
| | - Kevin C Zorn
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
- Centre Hospitalier de l'Université de Montréal Center Montreal Quebec Canada
| | - Emanuele Montanari
- Department of Urology IRCCS Fondazione Ca’ Granda‐Ospedale Maggiore Policlinico University of Milan Milan Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology URI IRCCS Ospedale San Raffaele Vita‐Salute San Raffaele University Milan Italy
| | - Luca Carmignani
- Academic Department of Urology IRCCS Policlinico San Donato University of Milan Milan Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal Institut du cancer de Montréal Montreal Quebec Canada
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83
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Baldissera Aradas JV, Rodríguez Villamil L, Fernández-Pello Montes S, Gil Ugarteburu R, Mosquera Madera J. Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach. Actas Urol Esp 2018; 42:649-658. [PMID: 29576194 DOI: 10.1016/j.acuro.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. MATERIALS AND METHODS We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. RESULTS Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. CONCLUSION Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases.
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Affiliation(s)
| | - L Rodríguez Villamil
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | | | - R Gil Ugarteburu
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - J Mosquera Madera
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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84
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Kim SH, Song MK, Kim JK, Hong B, Kang SH, Ku JH, Jeong BC, Seo HK. Laparoscopy versus Open Nephroureterectomy in Prognostic Outcome of Patients with Advanced Upper Tract Urothelial Cancer: A Retrospective, Multicenter, Propensity-Score Matching Analysis. Cancer Res Treat 2018; 51:963-972. [PMID: 30322230 PMCID: PMC6639211 DOI: 10.4143/crt.2018.465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma. Materials and Methods The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Society of Anesthesiologists score, tumor location, grade, pathologic T and N categories, the presence of lymphovascular invasion, and follow-up duration. The Kaplan-Meier with log-rank tests and clustered Cox regression were used to compare the estimated rates of survival for each surgical approach and to investigate the effect of the surgical approach on each prognostic outcome. Results Six hundred thirty-eight propensity-score matching pairs (n=1,276) were compared; LNU was significantly better than ONU in all types of survival, including intravesical recurrence-free survival (IVRFS), disease-free survival, overall survival (OS), and cancer-specific survival (CSS) (p < 0.05). The 3-year OS and CSS rates were significantly higher with LNU than with ONU (p < 0.05). Compared with ONU, LNU had significantly better 3-year OS and CSS rates (82.9% and 86.2% vs. 78.3% and 81.8%); there were no differences at 5 years. In subgroup analysis of the early-staged group, advanced-stage group, lymph node–positive group, and lymph node–negative group, the two approaches did not significantly affect prognostic outcomes, except LNU improved the IVRFS in the lymph node–negative or no history of previous bladder cancer group. Conclusion LNU had a significantly better prognostic outcome than ONU after propensity-score matching.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
| | - Mi Kyung Song
- Biometrics Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Jung Kwon Kim
- Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Kyung Seo
- Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
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85
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Rouprêt M, Xylinas E, Colin P, Houédé N, Compérat E, Audenet F, Larré S, Masson-Lecomte A, Pignot G, Brunelle S, Roumiguié M, Neuzillet Y, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la voie excrétrice supérieure French ccAFU guidelines — Update 2018—2020: Upper tract urothelial carcinoma. Prog Urol 2018; 28:S32-S45. [PMID: 30318333 DOI: 10.1016/j.purol.2018.07.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.005.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.005.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n∘5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude Bernard, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59042 Lille, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie Médicale, CHU Caremaux, Montpellier université, 30029 Nîmes, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital tenon, HUEP, Sorbonne Université, GRC n∘5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Européen-Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, 51100 Reims, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13009 Marseille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13009 Marseille, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 31400 Toulouse, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Européen-Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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86
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Huguet J, Rosales A, Breda A, Palou J. Atypical relapses in laparoscopic and robot-assisted surgery of urothelial carcinoma of the urinary tract and bladder. Actas Urol Esp 2018; 42:485-487. [PMID: 29903613 DOI: 10.1016/j.acuro.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- J Huguet
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Rosales
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Breda
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
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87
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Pathak RA, Hemal AK. Techniques and Outcomes of Robot-assisted Nephro-ureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Focus 2018; 4:657-661. [PMID: 30146238 DOI: 10.1016/j.euf.2018.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/16/2018] [Accepted: 08/10/2018] [Indexed: 11/24/2022]
Abstract
Radical nephro-ureterectomy and bladder cuff excision (RNUBCE) is the gold standard treatment for upper tract urothelial carcinoma (UTUC). RNUBCE can be performed via an open, laparoscopic or robot-assisted approach. The primary objective of this narrative mini-review is to report the techniques and outcomes for robot-assisted RNUBCE in the published literature. Relevant articles were selected utilizing the following search categories: "robot nephro-ureterectomy", "robot-assisted nephro-ureterectomy", and "robot upper tract urothelial carcinoma". Different techniques in terms of patient positioning, port placement, lymph node dissection, and bladder cuff excision have been reported in the literature. Despite these varied techniques, perioperative outcomes of robot-assisted laparoscopic RNUBCE are favorable. In all, a total of 204 patients underwent RNUBCE, with a mean operating room time of 229.7min, mean blood loss of 189ml, and mean length of stay of 3.65 d. Further studies are needed to validate oncologic outcomes. PATIENT SUMMARY: Patients with high-risk upper tract urothelial carcinoma require complete removal of the kidney, ureter, and bladder cuff, along with a lymph node dissection. Although the procedure can be performed via an open approach, minimally-invasive surgery represents an alternative. Herein, we describe the techniques and outcomes of robot-assisted radical nephro-ureterectomy and bladder cuff excision.
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Affiliation(s)
- Ram A Pathak
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
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Pradere B, Peyronnet B, Delporte G, Manach Q, Khene ZE, Moulin M, Roumiguié M, Rizk J, Brichart N, Beauval JB, Cormier L, Bex A, Rouprêt M, Bruyère F, Bensalah K. Intraoperative Cyst Rupture during Partial Nephrectomy for Cystic Renal Masses-Does it Increase the Risk of Recurrence? J Urol 2018; 200:1200-1206. [PMID: 29935273 DOI: 10.1016/j.juro.2018.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes. MATERIALS AND METHODS All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test. RESULTS Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20). CONCLUSIONS Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France.
| | - Benoit Peyronnet
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Gauthier Delporte
- Department of Urology, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Quentin Manach
- Department of Urology, Hôpital Pitié-Salpetrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zine-Eddine Khene
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Morgan Moulin
- Department of Urology, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Mathieu Roumiguié
- Department of Urology, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Jérome Rizk
- Department of Urology, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Nicolas Brichart
- Department of Urology, Centre Hospitalier Orléans, Orléans, France
| | | | - Luc Cormier
- Department of Urology, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Axel Bex
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpetrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Franck Bruyère
- Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France
| | - Karim Bensalah
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
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89
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Freifeld Y, Krabbe LM, Clinton TN, Woldu SL, Margulis V. Therapeutic strategies for upper tract urothelial carcinoma. Expert Rev Anticancer Ther 2018; 18:765-774. [PMID: 29848133 DOI: 10.1080/14737140.2018.1481395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many controversies exist regarding the appropriate management of patients with upper tract urothelial carcinoma (UTUC), including staging, surgical management, use of systemic therapy, and prevention of bladder recurrence. Due to the rarity of this condition, high-level evidence is often lacking and in many cases guidelines are extrapolated from existing evidence on urothelial bladder cancer. Areas covered: This review paper summarizes the evidence on proper diagnosis and staging, surgical techniques, prevention of bladder recurrences, the use of local or systemic treatments in both neoadjuvant and adjuvant settings as well as special consideration for hereditary UTUC. Expert commentary: UTUC is a rare malignancy and slow progress is being made in the acquisition of high-quality evidence in this field. Treatments that facilitate preservation of the kidney are being explored such as advanced endoscopic techniques or partial resection of ureteral disease with seemingly acceptable oncological results. Further prospective evidence is needed.
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Affiliation(s)
- Yuval Freifeld
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Laura-Maria Krabbe
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA.,b Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Timothy N Clinton
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Solomon L Woldu
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Vitaly Margulis
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
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