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Bignante G, Manfredi C, Lasorsa F, Orsini A, Licari LC, Bologna E, Roadman DF, Amparore D, Lucarelli G, Schips L, Fiori C, Porpiglia F, Autorino R. Incidence, Timing, and Pattern of Atypical Recurrence after Minimally Invasive Surgery for Urothelial Carcinoma. J Clin Med 2024; 13:3537. [PMID: 38930066 PMCID: PMC11204747 DOI: 10.3390/jcm13123537] [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: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
The management of urothelial carcinoma has evolved with the introduction of minimally invasive techniques such as laparoscopic or robotic procedures, challenging the traditional approach of open surgery, and giving rise to atypical recurrences (ARs). ARs include port-site metastasis and peritoneal carcinomatosis, yet discrepancies persist among authors regarding their precise classification. Incidence rates of ARs vary widely across studies, ranging from less than 1% to over 10% in both muscle-invasive bladder cancer (MIBC) and upper tract urothelial tumor (UTUC). Peritoneal metastases predominate as the most common ARs in patients with MIBC, while retroperitoneal metastases are prevalent in those with UTUC due to differing surgical approaches. The timing of AR presentation and survival outcomes closely mirror those of conventional recurrences, with which they are frequently associated. Pneumoperitoneum has progressively been regarded less as the cause of ARs, while surgical-related risk factors have gained prominence. Current major surgical-related causes include tumor spillage and urinary tract violation during surgery, avoidance of endo bag use for specimen extraction, and low surgical experience. Factors such as tumor stage, histological variants, and lympho-vascular invasion correlate with the risk of ARs, suggesting a close association with tumor biology. Further studies are required to better understand the incidence, risk factors, characteristics, and outcomes of ARs.
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Affiliation(s)
- Gabriele Bignante
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Turin, Italy; (D.A.); (C.F.); (F.P.)
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Lasorsa
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area-Urology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Orsini
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy;
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Daniel F. Roadman
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Turin, Italy; (D.A.); (C.F.); (F.P.)
| | - Giuseppe Lucarelli
- Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area-Urology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy;
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Turin, Italy; (D.A.); (C.F.); (F.P.)
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Turin, Italy; (D.A.); (C.F.); (F.P.)
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA; (G.B.); (F.L.); (A.O.); (L.C.L.); (E.B.); (D.F.R.); (R.A.)
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Coleman JA, Yip W, Wong NC, Sjoberg DD, Bochner BH, Dalbagni G, Donat SM, Herr HW, Cha EK, Donahue TF, Pietzak EJ, Hakimi AA, Kim K, Al-Ahmadie HA, Vargas HA, Alvim RG, Ghafoor S, Benfante NE, Meraney AM, Shichman SJ, Kamradt JM, Nair SG, Baccala AA, Palyca P, Lash BW, Rizvi MA, Swanson SK, Muina AF, Apolo AB, Iyer G, Rosenberg JE, Teo MY, Bajorin DF. Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma. J Clin Oncol 2023; 41:1618-1625. [PMID: 36603175 PMCID: PMC10043554 DOI: 10.1200/jco.22.00763] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) has proven survival benefits for patients with invasive urothelial carcinoma of the bladder, yet its role for upper tract urothelial carcinoma (UTUC) remains undefined. We conducted a multicenter, single-arm, phase II trial of NAC with gemcitabine and split-dose cisplatin (GC) for patients with high-risk UTUC before extirpative surgery to evaluate response, survival, and tolerability. METHODS Eligible patients with defined criteria for high-risk localized UTUC received four cycles of split-dose GC before surgical resection and lymph node dissection. The primary study end point was rate of pathologic response (defined as < ypT2N0). Secondary end points included progression-free survival (PFS), overall survival (OS), and safety and tolerability. RESULTS Among 57 patients evaluated, 36 (63%) demonstrated pathologic response (95% CI, 49 to 76). A complete pathologic response (ypT0N0) was noted in 11 patients (19%). Fifty-one patients (89%) tolerated at least three complete cycles of split-dose GC, 27 patients (47%) tolerated four complete cycles, and all patients proceeded to surgery. With a median follow up of 3.1 years, 2- and 5-year PFS rates were 89% (95% CI, 81 to 98) and 72% (95% CI, 59 to 87), while 2- and 5-year OS rates were 93% (95% CI, 86 to 100) and 79% (95% CI, 67 to 94), respectively. Pathologic complete and partial responses were associated with improved PFS and OS compared with nonresponders (≥ ypT2N any; 2-year PFS 100% and 95% v 76%, P < .001; 2-year OS 100% and 100% v 80%, P < .001). CONCLUSION NAC with split-dose GC for high-risk UTUC is a well-tolerated, effective therapy demonstrating evidence of pathologic response that is associated with favorable survival outcomes. Given that these survival outcomes are superior to historical series, these data support the use of NAC as a standard of care for high-risk UTUC, and split-dose GC is a viable option for NAC.
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Affiliation(s)
| | - Wesley Yip
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Harry W. Herr
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kwanghee Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Min Y. Teo
- Memorial Sloan Kettering Cancer Center, New York, NY
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Shimura S, Matsumoto K, Ikeda M, Moroo S, Koguchi D, Taoka Y, Hirayama T, Murakami Y, Utsunomiya T, Matsuda D, Okuno N, Irie A, Iwamura M. A multi-institutional retrospective study of open versus laparoscopic nephroureterectomy focused on the intravesical recurrence. Asia Pac J Clin Oncol 2023; 19:71-78. [PMID: 35404494 DOI: 10.1111/ajco.13684] [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: 08/20/2020] [Revised: 08/28/2021] [Accepted: 09/12/2021] [Indexed: 01/20/2023]
Abstract
AIM Intravesical recurrence (IVR) after nephroureterectomy for upper tract urothelial carcinoma (UTUC) is relatively frequent, occurring in about 30-50% of patients. The aim of this study was to investigate the differences of the prognosis and IVR between open and laparoscopic surgery and to elucidate the risk factor of IVR. PATIENTS AND METHODS We retrospectively analyzed data from 403 patients with UTUC treated with laparoscopic or open nephroureterectomy at six affiliated hospitals between 1990 and 2015. The clinicopathological factors of each group were examined using Kaplan-Meier plots, and univariate and multivariate analyses. RESULTS There was no difference in recurrence and cancer-specific mortality between open and laparoscopic surgery in univariate and multivariate analyses. There was no significant difference in IVR rate between the laparoscopic and open groups (p = .22). Among the patients with IVR, 84% of patients relapsed within 2 years. Univariate analysis of IVR showed a significant increase in patients with low-grade (p = .03, HR = 1.64) or low-stage urothelial carcinoma (pT1 or lower, p = .006, HR = 1.77) with no lymph node involvement (p = .002, HR = 10.3) or lymphovascular invasion (p = .009, HR = 1.79). Surgical modality was not an independent factor. In multivariate analysis, there was no independent predictive factor for IVR. CONCLUSIONS There was no difference in recurrence, cancer-specific mortality, and IVR between open and laparoscopic surgery. On the other hand, our results suggested that the low malignant potential tumor may be a risk factor for IVR. This finding provides insight into IVR, which may help with the development of personalized prevention and treatment strategies.
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Affiliation(s)
- Soichiro Shimura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shigenori Moroo
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Dai Koguchi
- Department of Urology, Kitasato University Medical Center, Kitamoto, Japan
| | - Yoshinori Taoka
- Department of Urology, Kitasato University Medical Center, Kitamoto, Japan
| | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Takuji Utsunomiya
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Daisuke Matsuda
- Department of Urology, Higashiyamato Hospital, Higashiyamato, Japan
| | - Norihiko Okuno
- Department of Urology, National Hospital Organization Sagamihara Hospital, Sagamihara, Japan
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
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Liu G, Yao Z, Chen G, Li Y, Liang B. Laparoscopic compared with open nephroureterectomy in upper urinary tract urothelial carcinoma: A systemic review and a meta-analysis. Int J Clin Pract 2021; 75:e14639. [PMID: 34309982 DOI: 10.1111/ijcp.14639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We performed a meta-analysis to evaluate the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects. METHODS A systematic literature search up to January 2021 was done and 36 studies included 23 013 subjects with upper urinary tract urothelial carcinoma at the start of the study; 8178 of them were laparoscopic nephroureterectomy, and 14 835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model. RESULTS Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91-66.90, P < .001), shorter hospital stay (MD, -1.71; 95% CI, -2.42 to -1.00, P < .001), lower blood loss (MD, -133.82; 95% CI, -220.92 to -46.73, P = .003), lower transfusion need (OR, 0.56; 95% CI, 0.47-0.67, P < .001) and lower overall complication (OR, 0.79; 95% CI, 0.70-0.90, P < .001) compared with open nephroureterectomy. However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2-5-years recurrence-free survival (OR, 0.90; 95% CI, 0.69-1.18, P = .46), 2-5-years cancer-specific survival (OR, 0.94; 95% CI, 0.69-1.28, P = .68) and 2-5-years overall survival (OR, 1.31; 95% CI, 0.91-1.87, P = .15). CONCLUSIONS Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, lower blood loss, transfusion need and overall complication compared with open nephroureterectomy. Further studies are required to validate these findings.
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Affiliation(s)
- Guihong Liu
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Zeqin Yao
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Guoqiang Chen
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Yalang Li
- Department of Urology, Yuzhou People's Hospital, Xuchang, China
| | - Bing Liang
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
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Liu G, Yao Z, Chen G, Li Y, Liang B. Open Nephroureterectomy Compared to Laparoscopic in Upper Urinary Tract Urothelial Carcinoma: A Meta-Analysis. Front Surg 2021; 8:729686. [PMID: 34485377 PMCID: PMC8414582 DOI: 10.3389/fsurg.2021.729686] [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: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background: In this meta-analysis, we will focus on evaluating the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects. Methods: A systematic literature search up to January 2021 was performed, and 36 studies included 23,013 subjects with upper urinary tract urothelial carcinoma at the start of the study; of them, 8,178 were laparoscopic nephroureterectomy, and 14,835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to evaluate the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model. Results: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91–66.90, p < 0.001), shorter hospital stay (MD, −1.71; 95% CI, −2.42 to −1.00, p < 0.001), lower blood loss (MD, −133.82; 95% CI, −220.92 to −46.73, p = 0.003), lower transfusion need (OR, 0.56; 95% CI, 0.47–0.67, p < 0.001), and lower overall complication (OR, 0.79; 95% CI, 0.70–0.90, p < 0.001) compared with open nephroureterectomy. However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2–5 years recurrence-free survival (OR, 0.90; 95% CI, 0.69–1.18, p = 0.46), 2–5 years cancer-specific survival (OR, 0.94; 95% CI, 0.69–1.28, p = 0.68), and 2–5 years overall survival (OR, 1.31; 95% CI, 0.91–1.87, p = 0.15). Conclusion: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, and lower blood loss, transfusion need, and overall complication compared to open nephroureterectomy. Further studies are required to validate these findings.
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Affiliation(s)
- Guihong Liu
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Zeqin Yao
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Guoqiang Chen
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Yalang Li
- Department of Urology, Yuzhou People's Hospital, Xuchang, China
| | - Bing Liang
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
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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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Yamamoto S, Sakamoto S, Imamura Y, Sazuka T, Nakamura K, Inoue T, Chiba K, Miyazaki K, Inoue A, Nagata M, Ichikawa T. Intravesical irrigation might prevent bladder recurrence in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 2019; 26:791-796. [PMID: 31081198 DOI: 10.1111/iju.14014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To examine the effectiveness of intravesical irrigation with physiological saline solution or distilled water for the prevention of bladder recurrence in patients undergoing laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. METHODS This retrospective study involved 109 upper urinary tract urothelial carcinoma patients who underwent laparoscopic nephroureterectomy, and were evaluated at Chiba University Hospital and Yokohama Rosai Hospital between 2001 and 2018. We investigated the outcomes and analyzed various clinical factors including with or without intravesical irrigation related to bladder carcinoma recurrence after surgery. Physiological saline solution or distilled water was used for irrigation, which was carried out only during surgery. RESULTS The median follow-up period after surgery was 26.1 months. Bladder recurrence was confirmed within 2 years for 45 of the 109 patients in the present study. Irrigation was carried out for 48 cases (distilled water, 26 patients; physiological saline solution, 22 patients). Tumor grade (G1-2 vs G3; P = 0.05) and intravesical irrigation (yes vs no; P = 0.0058) were related to bladder recurrence on univariate analyses. On multivariate analyses, intravesical irrigation was the independent factor involved in the prevention of bladder recurrence (P = 0.0051). Comparison between the irrigation and non-irrigation groups showed that bladder recurrence rates were significantly lower in the irrigation group (irrigation group vs non-irrigation group: 25.0% vs 52.5%, P = 0.0066). There was no significant difference in the recurrence rate between the two solutions used for irrigation. CONCLUSIONS Intravesical irrigation during surgery of upper urinary tract urothelial carcinoma might decrease postoperative bladder recurrence rates.
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Affiliation(s)
| | | | - Yusuke Imamura
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | | | - Toshihito Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | | | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
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Peyronnet B, Seisen T, Dominguez-Escrig JL, Bruins HM, Yuan CY, Lam T, Maclennan S, N’dow J, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, Mostafid H, van Rhijn BW, Gontero P, Palou J, Shariat SF, Roupret M. Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review. Eur Urol Focus 2019; 5:205-223. [DOI: 10.1016/j.euf.2017.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/10/2017] [Accepted: 10/10/2017] [Indexed: 01/16/2023]
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Liu F, Guo W, Zhou X, Ding Y, Ma Y, Hou Y, Kong X, Wang Z. Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11954. [PMID: 30170392 PMCID: PMC6393120 DOI: 10.1097/md.0000000000011954] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU) for the treatment of upper urinary tract urothelial carcinoma (UTUC). METHODS PubMed, Embase, and Cochrane databases were selected for systematic review of trials that compared outcomes of LNU and ONU. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. RESULTS LNU was associated with longer operation time (P < .001), shorter hospital stay (P < .001), less blood loss (P = .006) and lower rate of transfusion (P < .001). The occurrence of complications, including minor (P = .52), major (P = .21) and total complications (P = .19) were similar between LNU and ONU. There was no significant difference in the rate of 5-year recurrence-free survival (P = .90), 5-year cancer-specific survival (P = .12), and 5-year overall survival (P = .11) as well as 2-year RFS (P = .84), 2-year CSS (P = .86), and 2-year OS (P = .25). CONCLUSION Our results indicated that LNU is a safe and effective method to treat UTUC. Given the limitations of this study, further multicenter, randomized trials are required to confirm these findings.
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Affiliation(s)
| | | | | | - Youpeng Ding
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Yanan Ma
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Yi Hou
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Xiangbo Kong
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Zhixin Wang
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
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Nouralizadeh A, Tabatabaei S, Basiri A, Simforoosh N, Soleimani M, Javanmard B, Ansari A, Shemshaki H. Comparison of Open Versus Laparoscopic Versus Hand-Assisted Laparoscopic Nephroureterectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:656-681. [DOI: 10.1089/lap.2017.0662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Tabatabaei
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Urology, Moddares University Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Department of Urology, Shohada University Hospital, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari
- Department of Urology, Shohada University Hospital, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Shemshaki
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Liu JY, Dai YB, Zhou FJ, Long Z, Li YH, Xie D, Liu B, Tang J, Tan J, Yao K, He LY. Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study. BMC Surg 2017; 17:8. [PMID: 28095848 PMCID: PMC5240226 DOI: 10.1186/s12893-016-0202-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/30/2016] [Indexed: 12/18/2022] Open
Abstract
Background Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1–4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1–4/N0-X UTUC. Methods We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1–4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox’s proportional hazards model was used for univariate and multivariate analysis. Results The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P < 0.05). The predicted 5-year intravesical recurrence- free survival (RFS) (79% vs. 88%, P = 0.204), overall RFS (47% vs. 59%, P = 0.076), cancer-specific survival (CSS) (63% vs. 70%, P = 0.186), and overall survival (OS) (61% vs. 55%, P = 0.908) rates did not differ between the ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46–3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54–1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616–3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81–3.17, P = 0.17). Conclusions The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1–4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.
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Affiliation(s)
- Jian-Ye Liu
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Ying-Bo Dai
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Fang-Jian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Zhi Long
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yong-Hong Li
- Department of Urology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Dan Xie
- Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Bin Liu
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jin Tang
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jing Tan
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Le-Ye He
- Department of Urology, The Third Xiangya Hospital of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China. .,Institute of Prostate Disease of Central South University, No.138, Tongzipo Road, Changsha, 410013, Hunan, China.
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12
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Kitamura H, Maeda T, Tanaka T, Fukuta F, Kobayashi K, Nishiyama N, Takahashi S, Masumori N. Comparison of laparoscopic, hand-assisted, and open surgical nephroureterectomy. JSLS 2016; 18:288-93. [PMID: 24960495 PMCID: PMC4035642 DOI: 10.4293/108680813x13794522666842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The aim of this study was to compare oncologic outcomes after laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy for upper urinary tract urothelial cancer. Methods: Between April 1995 and August 2010, 189 patients underwent laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, or open nephroureterectomy for upper urinary tract urothelial cancer. Of these patients, 110 with no previous or concurrent bladder cancer or any metastatic disease were included in this study. Cancer-specific survival, recurrence-free survival, and intravesical recurrence-free survival rates were analyzed by the Kaplan-Meier method and compared with the log-rank test. The median follow-up period for the cohort was 70 months (range, 6–192 months). Results: The 3 groups were well matched for tumor stage, grade, and the presence of lymphovascular invasion and concomitant carcinoma in situ. The estimated 5-year cancer-specific survival rates were 81.1%, 65.6%, and 65.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .4179). The estimated 5-year recurrence-free survival rates were 33.8%, 10.0%, and 41.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .0245). The estimated 5-year intravesical recurrence-free survival rates were 64.8%, 10.0%, and 76.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P < .0001). Conclusion: Although there was no significant difference in cancer-specific survival rate among the laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy groups, hand-assisted laparoscopic nephroureterectomy may be inferior to laparoscopic nephroureterectomy or open nephroureterectomy with regard to recurrence-free survival and intravesical recurrence-free survival rates.
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Affiliation(s)
- Hiroshi Kitamura
- Department of Urology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Toshihiro Maeda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Fumimasa Fukuta
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Takahashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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13
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Shan H, Wang X, Sun Q, Chen Q, Xu B, Hao Y, Xu W. Oncologic Results of Retroperitoneoscopic Versus Open Surgery for T2 Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:568-73. [DOI: 10.1016/j.clgc.2015.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 11/27/2022]
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14
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Kim HS, Ku JH, Jeong CW, Kwak C, Kim HH. Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol 2015; 34:859-69. [PMID: 26497823 DOI: 10.1007/s00345-015-1712-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/10/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in upper urinary tract urothelial carcinoma (UTUC) patients. METHODS We retrospectively analyzed the data of 371 UTUC patients who underwent ORNU (n = 271) or LRNU (n = 100) between 1992 and 2012. The survival outcomes included intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS). The Kaplan-Meier method and log-rank test were used to estimate and compare survival curves between groups. Factors associated with survival outcomes were evaluated using univariable and multivariable Cox proportional hazard models. RESULTS The three-year IVR-free survival rates were similar between the ORNU and LRNU groups (59.9 and 61.7 %, p = 0.267). However, the LRNU group showed worse five-year OS (59.1 vs. 75.2 %, p = 0.027) and CSS (66.1 vs. 80.2 %, p = 0.015) rates than the ORNU group. In particular, on stratifying the study cohort by pathological stages, significant differences in OS (p = 0.007) and CSS (p = 0.005) between the surgical approaches were observed only in locally advanced disease (pT3/T4). In multivariable analysis, LRNU was an independent predictor of worse OS (p = 0.001) and CSS (p = 0.006) than ORNU. Likewise, in multivariable analysis in patients with pT3/T4 stage, LRNU was significantly associated with worse OS (hazard ratio [HR] 2.59, p = 0.001) and CSS (HR 2.50, p = 0.005). CONCLUSIONS Our data suggest that in UTUC patients, LRNU, compared to ORNU, is generally associated with unfavorable OS and CSS results. In particular, LRNU should be performed in locally advanced UTUC patients after careful consideration of its impact on patient survival.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea. .,Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
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15
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Guo G, Yang Y, Dong J, Zhenhong Z, Zhang X. A New 2-Micrometer Continuous Wave Laser Method for Management of the Distal Ureter in Retroperitoneal Laparoscopic Nephroureterectomy. J Endourol 2015; 29:430-4. [PMID: 25558002 DOI: 10.1089/end.2014.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gang Guo
- Department of Urology, PLA General Hospital, Beijing, China
| | - Yong Yang
- Department of Urology, PLA General Hospital, Beijing, China
| | - Jun Dong
- Department of Urology, PLA General Hospital, Beijing, China
| | - Zhou Zhenhong
- Department of Pathology, PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, PLA General Hospital, Beijing, China
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Risk factors for intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: A meta-analysis1These authors equally dedicated to this article. Urol Oncol 2014; 32:989-1002. [DOI: 10.1016/j.urolonc.2014.01.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/06/2014] [Accepted: 01/24/2014] [Indexed: 12/22/2022]
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17
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Oya M, Kikuchi E. Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition). Int J Urol 2014; 22:3-13. [PMID: 25243652 DOI: 10.1111/iju.12630] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/24/2023]
Abstract
Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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18
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Blackmur JP, Stewart GD, Egong EA, Cutress ML, Tolley DA, Riddick AC, McNeill SA. Matched-Pair Analysis of Open versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Cell Carcinoma. Urol Int 2014; 94:156-62. [DOI: 10.1159/000364833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022]
Abstract
Objective: Laparoscopic nephroureterectomy (LNU) offers a superior morbidity profile compared with open nephroureterectomy (ONU) in treating upper urinary tract urothelial cell carcinoma. Evidence of oncological equivalence between LNU and ONU is limited. We compare operative and oncological outcomes for LNU and ONU using matched-pair analysis. Methods: Of 159 patients who underwent a nephroureterectomy at a single institution between April 1992 and April 2010, 13 pairs of ONU and LNU patients were matched for gender, age, tumour location, tumour grade and stage. Operative details, post-operative characteristics and recurrences were collated and survival rates analysed using the Kaplan-Meier method. Results: There was no significant difference in mean operation time between LNU (191 min) and ONU (194 min, p = 0.92). There was no significant difference in the 5-year survival rate between LNU and ONU (overall survival 59.1% vs. 73.5%, p = 0.18; progression-free survival 24.0% vs. 56.0%, p = 0.14; cancer-specific survival 60.9% vs. 73.5%, p = 0.56; bladder cancer recurrence-free survival 8.7% vs. 0.0%, p = 0.09). Conclusion: Amidst limited RCT and comparative studies, this study presents further evidence of oncological equivalence between LNU and ONU. There was a trend towards poorer outcomes following LNU though, which merits further study.
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Marshall S, Stifelman M. Robot-assisted surgery for the treatment of upper urinary tract urothelial carcinoma. Urol Clin North Am 2014; 41:521-37. [PMID: 25306164 DOI: 10.1016/j.ucl.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Robot-assisted laparoscopic surgery is increasingly used in urologic oncologic surgery. Robotic nephroureterectomy is still a relatively new technique. As upper tract urothelial carcinoma is a rare disease, intermediate- and long-term outcome data are scarce. However, robotic nephroureterectomy does seem to offer advantages to open and laparoscopic counterparts, with comparable short-term oncologic and functional outcomes. Here the authors review the robotic surgical management of upper tract urothelial carcinoma, with a review of the steps and tips on making this approach more widely adoptable.
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Affiliation(s)
- Susan Marshall
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA.
| | - Michael Stifelman
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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Sun M, Abdo A, Abdollah F, Schmitges J, Thuret R, Jeldres C, Shariat SF, Perrotte P, Karakiewicz PI. Management of upper urinary tract urothelial carcinoma. Expert Rev Anticancer Ther 2014; 10:1955-65. [DOI: 10.1586/era.10.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Kapoor A, Allard CB, Black P, Kassouf W, Morash C, Rendon R. Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma. Can Urol Assoc J 2013; 7:306-11. [PMID: 24319507 DOI: 10.5489/cuaj.1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
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22
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Pang K, Liu SB, Wei HB, Zhuo J, Li ML, Xia SJ, Sun XW. Two-micron thulium laser resection of the distal ureter and bladder cuff during nephroureterectomy for upper urinary tract urothelial carcinoma. Lasers Med Sci 2013; 29:621-7. [DOI: 10.1007/s10103-013-1365-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 06/04/2013] [Indexed: 12/01/2022]
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23
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Wang XQ, Jiang FM, Chen QH, Hou YC, Zhang HF, Hao YY, Zhang L, Wang CX. Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China. Can Urol Assoc J 2013; 7:E287-92. [PMID: 22630340 DOI: 10.5489/cuaj.11128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). METHODS Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. RESULTS The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3-57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrence-free survival. CONCLUSION The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy.
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Affiliation(s)
- Xiao-Qing Wang
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Feng-Ming Jiang
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Qi-Hui Chen
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Yu-Chuan Hou
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Hai-Feng Zhang
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Yuan-Yuan Hao
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Long Zhang
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
| | - Chun-Xi Wang
- Department of Urology, First Bethune Hospital of Jilin University, Changchun Jilin, China
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Metcalfe M, Kassouf W, Rendon R, Bell D, Izawa J, Chin J, Kapoor A, Matsumoto E, Lattouf JB, Saad F, Lacombe L, Fradet Y, Fairey A, Jacobson NE, Drachenberg D, Cagiannos I, So A, Black P. Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada. Can Urol Assoc J 2013; 6:455-62. [PMID: 23282664 DOI: 10.5489/cuaj.12146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION : We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes. METHODS : A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes. RESULTS : There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43). CONCLUSION : There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.
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Oncological Outcomes of Laparoscopic and Open Treatment (Nephroureterectomy) for Urothelial Tumors of the Upper Urinary Tract. Urologia 2012; 79 Suppl 19:82-5. [DOI: 10.5301/ru.2012.9721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/20/2022]
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Lee Z, Cadillo-Chavez R, Lee DI, Llukani E, Eun D. The technique of single stage pure robotic nephroureterectomy. J Endourol 2012; 27:189-95. [PMID: 22876964 DOI: 10.1089/end.2012.0394] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To describe a novel technique for a single setup approach for robotic radical nephroureterectomy (RANU) that does not require patient repositioning, port reassignment, or redocking of the robotic arms. MATERIALS AND METHODS Twenty consecutive patients underwent RANU at a single institution between January 2009 and January 2012. We implemented a unique port placement strategy based on a modified paramedian line (MPL), which allowed sufficient access to both the upper abdomen and the deep pelvis for radical NU with bladder cuff excision and concomitant lymphadenectomy. RESULTS The mean operative time was 161.3 minutes (range 91-330 minutes), mean estimated blood loss was 98.8 (range 50-200), and the mean hospital stay was 3 days (median 2 days, range 1-16 days). None of the procedures were converted to open or required blood transfusions. Lymphadenectomy was performed on 16 out of 20 patients, and the mean number of lymph nodes removed per patient when lymphadenectomy was performed was 14.1 (range 2-35). Three patients had positive lymph nodes. One patient had prolonged postoperative ileus, and one had a hospital course that was complicated by pneumonia. Mean patient follow-up was 13.5 months (range 1-24 months); one patient was found to have a recurrence at 3 month follow-up. CONCLUSION The use of our MPL line for novel port placement allows for an effective, efficient, and reproducible method for RANU without the need for repositioning of the patient or the robot.
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Affiliation(s)
- Ziho Lee
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Fairey AS, Kassouf W, Estey E, Tanguay S, Rendon R, Bell D, Izawa J, Chin J, Kapoor A, Matsumoto E, Black P, So A, Lattouf JB, Saad F, Drachenberg D, Cagiannos I, Lacombe L, Fradet Y, Jacobsen NEB. Comparison of oncological outcomes for open and laparoscopic radical nephroureterectomy: results from the Canadian Upper Tract Collaboration. BJU Int 2012; 112:791-7. [PMID: 23148712 DOI: 10.1111/j.1464-410x.2012.11474.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?Open radical nephroureterectomy (ORNU) with excision of the ipsilateral bladder cuff is a standard treatment for upper tract urothelial carcinoma (UTUC). However, over the past decade laparoscopic RNU (LRNU) has emerged as a minimally invasive surgical alternative. Data comparing the oncological efficacy of ORNU and LRNU have reported mixed results and the equivalence of these surgical techniques have not yet been established. We found that surgical approach was not independently associated with overall or disease-specific survival; however, there was a trend toward an independent association between LRNU and poorer recurrence-free survival (RFS). To our knowledge, this is the first large, multi-institutional analysis to show a trend toward inferior RFS in patients with UTUC treated with LRNU. OBJECTIVE To examine the association between surgical approach for radical nephroureterectomy (RNU) and clinical outcomes in a large, multi-institutional cohort, as there are limited data comparing the oncological efficacy of open RNU (ORNU) and laparoscopic RNU (LRNU) for upper urinary tract urothelial carcinoma (UTUC). PATIENTS AND METHODS Institutional RNU databases containing detailed information on patients with UTUC treated between 1994 and 2009 were obtained from 10 academic centres in Canada. Data were collected on 1029 patients and combined into a relational database formatted with patient characteristics, pathological characteristics, and survival status. Surgical approach was classified as ORNU (n = 403) or LRNU (n = 446). The clinical outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression analysis were used to analyse survival data. RESULTS Data were evaluable for 849 of 1029 (82.5%) patients. The median (interquartile range) follow-up duration was 2.2 (0.6-5.0) years. The predicted 5-year OS (67% vs 68%, log-rank P = 0.19) and DSS (73% vs 76%, log-rank P = 0.32) rates did not differ between the ORNU and LRNU groups; however, there was a trend toward an improved predicted 5-year RFS rate in the ORNU group (43% vs 33%, log-rank P = 0.06). Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with OS (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.63-1.27, P = 0.52) or DSS (HR 0.90, 95% CI 0.60-1.37, P = 0.64); however, there was a trend toward an independent association between surgical approach and RFS (HR 1.24, 95% CI 0.98-1.57, P = 0.08). CONCLUSION Surgical approach was not independently associated with OS or DSS but there was a trend toward an independent association between LRNU and poorer RFS. Further prospective evaluation is needed.
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Rai BP, Shelley M, Coles B, Somani B, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU Int 2012; 110:1426-35. [PMID: 22759317 DOI: 10.1111/j.1464-410x.2012.11341.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC) has significantly changed over the past two decades. Data for several new surgical techniques, including nephron-sparing surgery (NSS), is emerging. The study systematically reviewed the literature comparing (randomised and observational studies) surgical and oncological outcomes for various surgical techniques MEDLINE, EMBASE, Cochrane Library, CINAHL, British Nursing Index, AMED, LILACS, Web of Science, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, ISI proceedings, and PubMed were searched to identify suitable studies. Data were extracted from each identified paper independently by two reviewers (B.R. and B.S.) and cross checked by a senior member of the team. The data analysis was performed using the Cochrane software Review manager version 5. Comparable data from each study was combined in a meta-analysis where possible. For dichotomous data, odds ratios with 95% confidence intervals (CIs) were estimated based on the fixed-effects model and according to an intention-to-treat analysis. If the data available were deemed not suitable for a meta-analysis it was described in a narrative fashion. One randomised control trial (RCT) and 19 observational studies comparing open nephroureterectomy (ONU) and laparoscopic NU (LNU) were identified. The RCT reported the LNU group to have statistically significantly less blood loss (104 vs 430 mL, P < 0.001) and mean time to discharge (2.30 vs 3.65 days, P < 0.001) than the ONU group. At a median follow-up of 44 months, the overall 5-year cancer-specific survival (CSS; 89.9 vs 79.8%) and 5-year metastasis-free survival rates (77.4 vs 72.5%) for the ONU were better than for LNU, respectively, although not statistically significant. A meta-analysis of the observational studies favoured LNU group for lower urinary recurrence (P < 0.001) and distant metastasis. The meta-analyses for local recurrence for the two groups were comparable. One retrospective study comparing ONU with a percutaneous approach for grade 2 disease reported no significant differences in CSS rates (53.8 vs 53.3 months). Three retrospective studies compared NSS and radical NU, and reported no significant differences in overall CSS and recurrence-free survival between the two approaches. Five retrospective studies compared various techniques of en bloc excision of the lower ureter. No technique was reported to be better (operative and oncological) than any other. This review concludes that there is a paucity of good quality evidence for the various surgical approaches for UUT-TCC. The techniques have been assessed and reported in many retrospective single-centre studies favouring LNU for better perioperative outcomes and comparable oncological safety. The reported observational studies data is further supported by one RCT.
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Affiliation(s)
- Bhavan Prasad Rai
- Department of Urology, Medical Research Institute, Ninewells hospital and Medical School, Dundee, UK
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Upper tract urothelial carcinoma: current treatment and outcomes. Urology 2012; 79:749-56. [PMID: 22469572 DOI: 10.1016/j.urology.2011.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/26/2011] [Accepted: 12/15/2011] [Indexed: 01/12/2023]
Abstract
The reference standard treatment of upper tract urothelial carcinoma is open radical nephroureterectomy. Many centers have advocated less-invasive treatment modalities. We reviewed contemporary treatments of upper tract urothelial carcinoma and their outcomes. A MEDLINE search was conducted for all relevant published data during the past 15 years. Endoscopic management is feasible for low-grade disease with strict surveillance protocols. Radical nephroureterectomy remains the reference standard for upper tract urothelial carcinoma. The intermediate-term oncologic outcomes are similar between the laparoscopic and open approaches. Controversies still exist regarding the optimal management of the distal ureter, the utility of topical therapy, and the role of lymphadenectomy.
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Abstract
The last two decades have witnessed the rapid dissemination of robot-assisted laparoscopic urological surgery related to the technical advantages of this new laparoscopic tool. Master-slave systems ease intracorporeal anastomosis and the performance of technically highly demanding procedures, as reflected by a steep learning curve. Robot-assistance is particularly useful for partial nephrectomy, live-donor kidney transplantation, extended procedures, e.g. upper and lower urogenital tract resection and difficult anatomy as encountered in obese patients or patient with a history of multiple intraperitoneal procedures.
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Arai E, Kanai Y. DNA methylation profiles in precancerous tissue and cancers: carcinogenetic risk estimation and prognostication based on DNA methylation status. Epigenomics 2012; 2:467-81. [PMID: 22121905 DOI: 10.2217/epi.10.16] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Alterations in DNA methylation, which are associated with DNA methyltransferase abnormalities and result in silencing of tumor-related genes and chromosomal instability, are involved even in precancerous changes in various organs. DNA methylation alterations also account for the histological heterogeneity and clinicopathological diversity of human cancers. Therefore, we have analyzed DNA methylation on a genome-wide scale in clinical tissue samples. Our approach using the bacterial artificial chromosome array-based methylated CpG island amplification method has revealed that DNA methylation alterations correlated with the future development of more malignant cancers are already accumulated at the precancerous stage in the kidney, liver and urinary tract. DNA methylation profiles at precancerous stages are basically inherited by the corresponding cancers developing in individual patients. Such DNA methylation alterations may confer vulnerability to further genetic and epigenetic alterations, generate more malignant cancers, and thus determine patient outcome. On the basis of bacterial artificial chromosome array-based methylated CpG island amplification data, indicators for carcinogenetic risk estimation have been established using liver tissue specimens from patients with hepatitis virus infection, chronic hepatitis and liver cirrhosis or histologically normal urothelia, and for prognostication using biopsy or surgically resected specimens from patients with renal cell carcinoma, hepatocellular carcinoma and urothelial carcinoma. Such genome-wide DNA methylation profiling has now firmly established the clinical relevance of translational epigenetics.
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Affiliation(s)
- Eri Arai
- Pathology Division, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Ni S, Tao W, Chen Q, Liu L, Jiang H, Hu H, Han R, Wang C. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 2012; 61:1142-53. [PMID: 22349569 DOI: 10.1016/j.eururo.2012.02.019] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/07/2012] [Indexed: 02/06/2023]
Abstract
CONTEXT Laparoscopic nephroureterectomy (LNU) has increasingly been used as a minimally invasive alternative to open nephroureterectomy (ONU), but studies comparing the efficacy and safety of the two surgical procedures are still limited. OBJECTIVE Evaluate the oncologic and perioperative outcomes of LNU versus ONU in the treatment of upper urinary tract urothelial carcinoma. EVIDENCE ACQUISITION A systematic review and cumulative analysis of comparative studies reporting both oncologic and perioperative outcomes of LNU and ONU was performed through a comprehensive search of the Medline, Embase, and the Cochrane Library electronic databases. All analyses were performed using the Review Manager (RevMan) v.5 (Nordic Cochrane Centre, Copenhagen, Denmark) and Meta-analysis In eXcel (MIX) 2.0 Pro (BiostatXL) software packages. EVIDENCE SYNTHESIS Twenty-one eligible studies (1235 cases and 3093 controls) were identified. A significantly higher proportion of pTa/Tis was observed in LNU compared to ONU (27.52% vs 22.59%; p = 0.047), but there were no significant differences in other stages and pathologic grades (all p>0.05). For patients who underwent LNU, the 5-yr cancer-specific survival (CSS) rate was significantly higher, at 9% (p = 0.03), compared to those who underwent ONU, while the overall recurrence rate and bladder recurrence rate were notably lower, at 15% (p = 0.01) and 17% (p = 0.02), respectively. However, there were no statistically significant differences in 2-yr CSS, 5-yr recurrence-free survival (RFS), 5-yr overall survival (OS), 2-yr OS, and metastasis rates between LNU and ONU (all p>0.05). Moreover, there were no significant differences between LNU and ONU in terms of intraoperative complications, postoperative complications, and perioperative mortality (all p>0.05). The results of our study were mainly limited by the retrospective design of most of the individual studies included as well as selection biases based on different management of regional lymph nodes and pathologic characteristics. CONCLUSIONS Our data suggest that LNU offers reliable perioperative safety and comparable oncologic efficacy when compared to ONU. Given that some limitations cannot be overcome, well-designed prospective trials are needed to confirm our findings.
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Affiliation(s)
- Shaobin Ni
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Stewart GD, Humphries KJ, Cutress ML, Riddick ACP, McNeill SA, Tolley DA. Long-term comparative outcomes of open versus laparoscopic nephroureterectomy for upper urinary tract urothelial-cell carcinoma after a median follow-up of 13 years*. J Endourol 2011; 25:1329-35. [PMID: 21815793 DOI: 10.1089/end.2011.0223] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Open nephroureterectomy (ONU) rather than laparoscopic nephroureterectomy (LNU) is still regarded as the standard of care for extirpative surgical management of upper urinary tract urothelial-cell carcinoma (UUT-UCC). The longest published follow-up of LNU is 7 years. We report outcomes for patients having surgery ≥10 years ago. PATIENTS AND METHODS Consecutive patients with UUT-UCC who were treated with ONU (n=39) or LNU (n=23) between April 1992 to September 2000 were included. Preoperative, tumor, operative and postoperative characteristics, recurrence, and outcomes were collated. Survival was estimated using the Kaplan-Meier method. RESULTS Median follow-up of censored patients was 163 months (13.6 y). Estimated mean overall survival (OS) was 111 months for ONU and 103 months for LNU. Mean progression free survival (PFS) was 175 months for ONU and 143 months for LNU. Probability of PFS at 10 years was 79% for ONU and 76% for LNU and was unchanged at 15 years. There was no significant difference between ONU and LNU in terms of OS (P=0.51, log-rank test), PFS (P=0.70) or cancer-specific survival (CSS; P=0.43). There were no prognostic differences between ONU and LNU after correcting for confounding variables. There was no increase in the probability of a bladder cancer recurrence from 10 to 15 years postoperation. CONCLUSION Long-term follow-up of patients who were operated on more than 10 years ago suggests that LNU has oncologic equivalence to ONU because there were no significant differences in OS, PFS, or CSS between ONU and LNU patients followed for a median of 13 years.
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Affiliation(s)
- Grant D Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh , Department of Urology, Western General Hospital, Edinburgh, United Kingdom.
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Current status of laparoendoscopic single-site surgery in urology. World J Urol 2011; 27:767-73. [PMID: 19649638 DOI: 10.1007/s00345-009-0459-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 07/16/2009] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Laparoendoscopic single-site surgery (LESS) uses single incisions for the introduction of instruments through a specially designed multi-lumen single port (multi-port) for the performance of several urologic procedures. METHODS Literature review regarding the LESS approach took place on May 2009 and the experiences of our institutions were also included. RESULTS Almost all urologic intra-abdominal and pelvic procedures have been successfully and safely performed with the LESS approach. Nevertheless, current experience is limited and there are significant technical challenges to the performance of LESS techniques. CONCLUSIONS Wider adaptation of the approach requires refinement of LESS instrumentation to overcome the technical challenges of the approach. The improved outcome should also be documented with further clinical evaluation.
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Ariane MM, Colin P, Ouzzane A, Pignot G, Audouin M, Cornu JN, Albouy B, Guillotreau J, Neuzillet Y, Crouzet S, Hurel S, Arroua F, Bigot P, Marchand C, Fais PO, de la Taille A, Saint F, Ravier E, Matte A, Guy L, Bruyère F, Rouprêt M. Assessment of Oncologic Control Obtained After Open Versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinomas (UUT-UCs): Results from a Large French Multicenter Collaborative Study. Ann Surg Oncol 2011; 19:301-8. [DOI: 10.1245/s10434-011-1841-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 11/18/2022]
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Messer J, Lin YK, Raman JD. The role of lymphadenectomy for upper tract urothelial carcinoma. Nat Rev Urol 2011; 8:394-401. [DOI: 10.1038/nrurol.2011.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rai BP, Shelley M, Coles B, Biyani CS, El-Mokadem I, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database Syst Rev 2011:CD007349. [PMID: 21491399 DOI: 10.1002/14651858.cd007349.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures. OBJECTIVES To determine the best surgical management option for upper tract transitional cell carcinoma. SEARCH STRATEGY A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings. SELECTION CRITERIA The following criteria that were considered for this review.Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes. DATA COLLECTION AND ANALYSIS Two review authors examined the search results independently to identify trials for inclusion. MAIN RESULTS We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P < 0.001) and mean time to discharge (2.3 days versus 3.7, P < 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups. AUTHORS' CONCLUSIONS There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach.
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Affiliation(s)
- Bhavan Prasad Rai
- Department of Urology, Academic Clinical Practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, UK
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Hara N, Kitamura Y, Saito T, Wakatsuki S, Sakata Y, Komatsubara S. Nephrectomy Plus Endoscopy-Assisted Intussusception Ureterectomy for Patients with Renal Pelvic Cancer: Long-Term Oncologic Outcomes in Comparison with Nephroureterectomy Plus Bladder Cuff Removal. J Endourol 2011; 25:691-7. [DOI: 10.1089/end.2010.0336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Noboru Hara
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasuo Kitamura
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toshihiro Saito
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Shunji Wakatsuki
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasunosuke Sakata
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
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Walton TJ, Novara G, Matsumoto K, Kassouf W, Fritsche HM, Artibani W, Bastian PJ, Martínez-Salamanca JI, Seitz C, Thomas SA, Ficarra V, Burger M, Tritschler S, Karakiewicz PI, Shariat SF. Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int 2010; 108:406-12. [DOI: 10.1111/j.1464-410x.2010.09826.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Favaretto RL, Shariat SF, Chade DC, Godoy G, Kaag M, Cronin AM, Bochner BH, Coleman J, Dalbagni G. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol 2010; 58:645-51. [PMID: 20724065 DOI: 10.1016/j.eururo.2010.08.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 08/03/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. OBJECTIVE Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n=109) or LRN (n=53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. INTERVENTION All patients underwent RN. MEASUREMENTS Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. RESULTS AND LIMITATIONS Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p=0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p=0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p=0.4) or disease-specific mortality (p=0.9). This study is limited by its retrospective nature. CONCLUSIONS Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.
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Affiliation(s)
- Ricardo L Favaretto
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY 10065, USA
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Weizer AZ, Montgomery JS. The Role of Lymphadenectomy in Minimally Invasive Urologic Oncology. J Endourol 2010; 24:1229-40. [DOI: 10.1089/end.2009.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alon Z. Weizer
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S. Montgomery
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Stolzenburg JU, Kallidonis P, Oh MA, Ghulam N, Do M, Haefner T, Dietel A, Till H, Sakellaropoulos G, Liatsikos EN. Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting. J Endourol 2010; 24:239-45. [PMID: 20039829 DOI: 10.1089/end.2009.0296] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Laparoendoscopic single-site surgery (LESS) represents the latest innovation in laparoscopic surgery. We compare in dry and animal laboratory the efficacy of recently introduced pre-bent instruments with conventional laparoscopic and flexible instruments in terms of time requirement, maneuverability, and ease of handling. MATERIALS AND METHODS Participants of varying laparoscopic experience were included in the study and divided in groups according to their experience. The participants performed predetermined tasks in dry laboratory using all sets of instruments. An experienced laparoscopic surgeon performed 24 nephrectomies in 12 pigs using all sets of instruments. Single port was used for all instrument sets except for the conventional instruments, which were inserted through three ports. The time required for the performance of dry laboratory tasks and the porcine nephrectomies was recorded. Errors in the performance of dry laboratory tasks of each instrument type were also recorded. RESULTS Pre-bent instruments had a significant advantage over flexible instruments in terms of time requirement to accomplish tasks and procedures as well as maneuverability. Flexible instruments were more time consuming in comparison to the conventional laparoscopic instruments during the performance of the tasks. There were no significant differences in the time required for the accomplishment of dry laboratory tasks or steps of nephrectomy using conventional instruments through appropriate number of ports in comparison to pre-bent instruments through single port. DISCUSSION Pre-bent instruments were less time consuming and with better maneuverability in comparison to flexible instruments in experimental single-port access surgery. Further clinical investigations would elucidate the efficacy of pre-bent instruments.
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Bagley DH, Grasso M. Ureteroscopic laser treatment of upper urinary tract neoplasms. World J Urol 2010; 28:143-9. [PMID: 20229233 DOI: 10.1007/s00345-010-0525-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/18/2010] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Endoscopic management of upper urinary tract transitional cell carcinoma has assumed an important role in diagnosis and treatment. The introduction of small diameter rigid and flexible ureteroscopes has permitted access to the upper tract. Biopsy techniques have been developed for accurate diagnosis, and the addition of lasers has given the urologists an excellent tool for treatment. METHODS Medical literature available relative to the endoscopic laser treatment of upper tract neoplasms has been reviewed. RESULTS Ureteroscopic treatment has been characterized by good success with high recurrence rates, both in the upper tract and in the bladder. Bladder recurrence rates are similar to those seen after surgical treatment of upper tract tumors. Surveillance has been ureteroscopic since the other diagnostic options are inadequate. The holmium and neodymium:YAG lasers are the devices most commonly used now for the endoscopic treatment of upper tract tumors. CONCLUSION Ureteroscopic treatment of upper tract neoplasms usually with ablation and resection using the neodymium and holmium:YAG lasers is a current acceptable procedure. This should be considered as one of the options in tumor treatment.
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Affiliation(s)
- Demetrius H Bagley
- Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Room 1108, Philadelphia, PA 19107, USA.
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Alonso y Gregorio S, Sánchez S, Monasterio S, Girón M, Rando A, Tabernero Á, Hidalgo L, Cisneros J, de la Peña J. Abordaje del uréter distal en la nefroureterectomía laparoscópica. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70034-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ, Chou YH, Huang CH. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol 2010; 57:963-9. [PMID: 20079965 DOI: 10.1016/j.eururo.2009.12.032] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 12/25/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a lack of consensus regarding the prognostic significance of different approaches to the bladder cuff at surgery for primary upper urinary tract urothelial carcinoma (UUT-UC). OBJECTIVES To compare the oncologic outcomes following radical nephroureterectomy using three different methods of managing the bladder cuff. DESIGN, SETTING, AND PARTICIPANTS From January 1990 to December 2007, 414 patients with primary UUT-UC underwent radical nephroureterectomy at our institution. Of these, 301 were included in our study. INTERVENTION Three methods of bladder cuff excision-intravesical incision, extravesical incision, and transurethral incision (TUI)-were performed. MEASUREMENTS Patients' medical records were reviewed retrospectively. The clinicopathologic data and oncologic outcomes were compared among groups. RESULTS AND LIMITATIONS Of the 301 patients, 81 (26.9%) underwent the intravesical method, 129 (42.9%) underwent the extravesical technique, and 91 (30.2%) underwent TUI. There were no differences in clinical and histopathologic data among the three groups. When comparing the intravesical, extravesical, and TUI techniques, bladder recurrence developed in, respectively, 23.5%, 24.0%, and 17.6% cases (p=0.485); local retroperitoneal recurrence in 7.4%, 7.8%, and 5.5% (p=0.798); contralateral recurrence in 4.9%, 3.9%, and 2.2% (p=0.632); and distant metastasis in 7.4%, 10.4%, and 5.5% (p=0.564). There were no differences in recurrence-free and cancer-specific survival among the three groups (p=0.680 and 0.502, respectively). CONCLUSIONS The three techniques had comparable oncologic outcomes. Our data validate the TUI method of bladder cuff control in patients with primary UUT-UC without coexistent bladder tumors.
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Affiliation(s)
- Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Nishiyama N, Arai E, Chihara Y, Fujimoto H, Hosoda F, Shibata T, Kondo T, Tsukamoto T, Yokoi S, Imoto I, Inazawa J, Hirohashi S, Kanai Y. Genome-wide DNA methylation profiles in urothelial carcinomas and urothelia at the precancerous stage. Cancer Sci 2010; 101:231-40. [PMID: 19775289 PMCID: PMC11159941 DOI: 10.1111/j.1349-7006.2009.01330.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To clarify genome-wide DNA methylation profiles during multistage urothelial carcinogenesis, bacterial artificial chromosome (BAC) array-based methylated CpG island amplification (BAMCA) was performed in 18 normal urothelia obtained from patients without urothelial carcinomas (UCs) (C), 17 noncancerous urothelia obtained from patients with UCs (N), and 40 UCs. DNA hypo- and hypermethylation on multiple BAC clones was observed even in N compared to C. Principal component analysis revealed progressive DNA methylation alterations from C to N, and to UCs. DNA methylation profiles in N obtained from patients with invasive UCs were inherited by the invasive UCs themselves, that is DNA methylation alterations in N were correlated with the development of more malignant UCs. The combination of DNA methylation status on 83 BAC clones selected by Wilcoxon test was able to completely discriminate N from C, and diagnose N as having a high risk of carcinogenesis, with 100% sensitivity and specificity. The combination of DNA methylation status on 20 BAC clones selected by Wilcoxon test was able to completely discriminate patients who suffered from recurrence after surgery from patients who did not. The combination of DNA methylation status for 11 BAC clones selected by Wilcoxon test was able to completely discriminate patients with UCs of the renal pelvis or ureter who suffered from intravesical metachronous UC development from patients who did not. Genome-wide alterations of DNA methylation may participate in urothelial carcinogenesis from the precancerous stage to UC, and DNA methylation profiling may provide optimal indicators for carcinogenetic risk estimation and prognostication.
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Affiliation(s)
- Naotaka Nishiyama
- Pathology Division, National Cancer Center Research Institute, Tokyo, Japan
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Chung SD, Chen SC, Wang SM, Chueh SC, Lai MK, Huang CY, Pu YS, Huang KH, Yu HJ. Long-term outcome of hand-assisted laparoscopic nephroureterectomy for pathologic T3 upper urinary tract urothelial carcinoma. J Endourol 2009; 23:75-80. [PMID: 19178172 DOI: 10.1089/end.2008.0267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine the feasibility and long-term outcomes of hand-assisted laparoscopic nephroureterectomy (HALNU) compared with open nephroureterectomy (ONU) in the management of pT(3)N0 upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT(3)N0 UTT-UC were matched and compared with 31 patients who underwent ONU. The oncologic out-comes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival, were statistically analyzed. RESULTS The median follow-up period in the HALNU group was 72 months (range 33-111 months) and 115 months in the ONU group (range 24-161 months). Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 mL versus 487 mL; P = 0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancer-specific survival, and overall survival were also comparable in both groups. CONCLUSIONS HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT(3)N0UUT-UC.
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Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
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Capitanio U, Shariat SF, Isbarn H, Weizer A, Remzi M, Roscigno M, Kikuchi E, Raman JD, Bolenz C, Bensalah K, Koppie TM, Kassouf W, Fernández MI, Ströbel P, Wheat J, Zigeuner R, Langner C, Waldert M, Oya M, Guo CC, Ng C, Montorsi F, Wood CG, Margulis V, Karakiewicz PI. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol 2009; 56:1-9. [PMID: 19361911 DOI: 10.1016/j.eururo.2009.03.072] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/11/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce. OBJECTIVE We compared recurrence and cause-specific mortality rates of ONU and LNU. DESIGN, SETTING, AND PARTICIPANTS Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC). MEASUREMENTS Univariable and multivariable survival models tested the effect of procedure type (ONU [n=979] vs LNU [n=270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment. RESULTS AND LIMITATIONS Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p<0.001) and less lymphovascular invasion (14.8% vs 21.3%, p=0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p=0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p<0.001] and 2.0 [p=0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p=0.1 for both). CONCLUSIONS Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC.
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Affiliation(s)
- Umberto Capitanio
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Laparoscopic nephroureterectomy and management of the distal ureter: a review of current techniques and outcomes. Adv Urol 2009:721371. [PMID: 19148293 PMCID: PMC2615831 DOI: 10.1155/2009/721371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 11/03/2008] [Indexed: 12/31/2022] Open
Abstract
Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference. Our analysis of the literature reflects equivalent cancer control between LPN and OPN at intermediate follow-up with significantly improved perioperative morbidity following LPN. Several methods for bladder cuff excision have been advocated, however, no individual technique for management of the distal ureter proved superior. Overall, complete en-bloc resection with minimal disruption of the urinary tract should be optimized to maintain oncologic outcomes. Longer follow-up and prospective studies are needed to fully evaluate these techniques.
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Laparoscopic nephroureterectomy: oncologic outcomes and management of distal ureter; review of the literature. Adv Urol 2008:826725. [PMID: 19020656 PMCID: PMC2581730 DOI: 10.1155/2009/826725] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 08/07/2008] [Accepted: 09/15/2008] [Indexed: 12/02/2022] Open
Abstract
Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC). Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU). Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.
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