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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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Kanno T, Kobori G, Ito K, Nakagawa H, Takahashi T, Koterazawa S, Takaoka N, Somiya S, Haitani T, Nagahama K, Ito M, Megumi Y, Higashi Y, Moroi S, Akao T, Yamada H. Atypical Oncologic Failure After Laparoscopic Radical Nephroureterectomy in a Japanese Multicenter Study. J Endourol 2023; 37:793-800. [PMID: 37212267 DOI: 10.1089/end.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Objectives: To investigate the recurrence patterns and the atypical oncologic failure (AOF) defined as the presence of atypical recurrences, such as retroperitoneal carcinomatosis or port-site recurrence, after laparoscopic radical nephroureterectomy (LRNU). Methods: LRNU performed at three institutions were included in this retrospective study. The primary endpoints were the first recurrence site and recurrence-free survival. The recurrence sites were classified as atypical recurrences, such as retroperitoneal carcinomatosis or port-site recurrence, as well as distant, local, and intravesical. The Kaplan-Meier curves were obtained to elucidate the time until recurrence and survival. Results: A total of 283 patients were included in the final analysis. Postoperative pathology was T3 or higher in 112 (40%) patients. The median follow-up period was 31 months, and the 3-year recurrence-free, cancer-specific, and overall survival rates were 69.6%, 78.1%, and 72.0%, respectively. The first recurrence sites involved distant, local, atypical, and intravesical recurrences in 51 (18%), 36 (13%), 14 (5%), and 94 (33%) patients, respectively. Of the 14 patients with AOF, 12 had pathologically locally advanced tumors, but seven patients had a preoperative diagnosis of clinical stage T2 or less. Conclusion: A small number of AOF cases were found after LRNU for patients with upper tract urothelial carcinoma. Careful patient selection is critical for AOF prevention.
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Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Go Kobori
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | | | | | | | - Naoto Takaoka
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takao Haitani
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Kanji Nagahama
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Masaaki Ito
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yuzuru Megumi
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Seiji Moroi
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Toshiya Akao
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
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Liedberg F, Abrahamsson J, Bobjer J, Gudjonsson S, Löfgren A, Nyberg M, Sörenby A. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma-feasibility and complications: a single center experience. Scand J Urol 2022; 56:301-307. [PMID: 35736556 DOI: 10.1080/21681805.2022.2091018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery. OBJECTIVE To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure. METHODS The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days. RESULTS The median age was 75 [(Inter Quartile Range) IQR 70-80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4-5 complication. The median blood loss was 50 (IQR 20-100) ml and the median hospital stay was 6 (IQR 5-7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases). CONCLUSION Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications.
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Affiliation(s)
- F Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - J Abrahamsson
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - J Bobjer
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - S Gudjonsson
- Department of Urology, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Löfgren
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - M Nyberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
| | - A Sörenby
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Lund, Sweden
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