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Ji H, Wu Q, Ji J, Qian Y, Cai L, Bai K, Cao Q, Yang X, Cao Y, Lv Q, Li P. Modified robot-assisted nephroureterectomy with ureteral catheterization for radical resection of the distal ureter: Procedures and short-term outcomes. Heliyon 2024; 10:e29198. [PMID: 38644863 PMCID: PMC11033093 DOI: 10.1016/j.heliyon.2024.e29198] [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: 11/08/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives To describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU). Methods We retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups. Results Surgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump. Conclusions Our novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.
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Affiliation(s)
- Hao Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jianbo Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Department of Urology, Yancheng Third People's Hospital, Yancheng Clinical Medical College, Nanjing Medical University, Yancheng, PR China
| | - Yuhang Qian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Kexin Bai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yongke Cao
- Department of English, Nanjing Medical University, Nanjing, PR China
| | - Qiang Lv
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Department of Urology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, PR China
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Gallioli A, Baboudjian M, Diana P, Moschini M, Xylinas E, Del Giudice F, Laukhtina E, Soria F, Mari A, Subiela JD, Rouy M, Territo A, Basile G, Palou J, Pradere B, Breda A. Perioperative and oncological outcomes of distal ureter management during nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis. Minerva Urol Nephrol 2023; 75:672-682. [PMID: 38126282 DOI: 10.23736/s2724-6051.23.05448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The best approach of the bladder cuff (i.e., transvesical, extravesical, endoscopic) during radical nephroureterectomy (RNU) remains an unsolved question. The aim of this review is to compare the oncological and perioperative outcomes among three different approaches of the distal ureter during RNU. EVIDENCE ACQUISITION A literature search was conducted through June 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The primary outcome was bladder recurrence-free survival and secondary outcomes included: perioperative outcomes, metastasis-free survival, and cancer-specific survival. EVIDENCE SYNTHESIS A total of 19 non-randomized studies comprising 6581 patients met our inclusion criteria. The risk of bladder recurrence, metastasis and cancer-related death did not differ significantly between each approach (all P>0.05). In subgroup analysis excluding patients with history of bladder cancer, the risk of bladder recurrence remained similar between each approach (all P>0.05). There was no significant difference in terms of operative time, estimated blood loss, length of hospital stay, and postoperative complications between each approach (all P>0.05). The main limitation is the retrospective design of 18/19 included studies. CONCLUSIONS The present systematic review and meta-analysis highlights the lack of high-level evidence on distal ureter management during RNU. On the basis of the available data, the present review supports the equivalence of different techniques of bladder cuff excision during RNU. The extravesical approach seems non-inferior to the transvesical approach in terms of oncological and perioperative outcomes.
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Affiliation(s)
- Andrea Gallioli
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Michael Baboudjian
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, APHM, North Academic Hospital, Marseille, France
- Department of Urology, APHM, La Conception Hospital, Marseille, France
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Pietro Diana
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Marco Moschini
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital Paris Descartes University, Paris, France
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Sapienza University, Umberto I Polyclinic Hospital, Rome, Italy
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain -
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Joan Palou
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
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Margulis V, Ghandour RA, Singla N. Nephroureterectomy for Upper Tract Urothelial Carcinoma: Indications and Technique. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li Z, Li X, Li Y, Liu Y, Du P, Liu Z, Xiao K. A Novel Nomogram for Predicting the Survival of Patients with Invasive Upper Tract Urothelial Carcinoma. J Cancer 2021; 12:790-798. [PMID: 33403036 PMCID: PMC7778545 DOI: 10.7150/jca.50419] [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: 07/07/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022] Open
Abstract
Purpose: Available tools for the prediction of the prognosis of patients with upper tract urothelial carcinoma (UTUC) are unified. We determined whether a novel nomogram is effective in estimating the survival of patients with invasive UTUC. Methods: From January 2004 to December 2015, 4796 invasive UTUC patients in the Surveillance, Epidemiology and End Results database underwent radical nephroureterectomy (RNU) for invasive UTUC. The medical records of the patients were randomly (7:3) divided into the training and validation cohorts. The independent factors included in the nomogram were selected by multivariate analyses. The nomogram was developed based on the training cohort. Bootstrap validation was applied to validate the nomogram, whereas external validation was performed using the validation cohort. The accuracy and discrimination of the nomogram were assessed using concordance indices (C-indices) and calibration curves. Results: The multivariate Cox regression model identified that age, tumor stage, node stage, metastasis stage and grade were associated with survival. In the training set, the nomogram, which included the above factors, exhibited discrimination power superior to that of the 8th American Joint Committee on Cancer (AJCC) TNM classification (Harrell's C-index, 0.74 vs. 0.71; P < 0.001). The nomogram showed better probability of survival agreement with the C-index than the AJCC-TNM staging system in the bootstrap validation (0.74 vs. 0.70; P < 0.001) and validation set (Harrell's C-index, 0.77 vs. 0.73; P < 0.001). The validation revealed that this nomogram exhibited excellent discrimination and calibration capacities. Conclusion: An accurate novel nomogram that is superior to the current AJCC-TNM staging system was established for the prediction of CSS after RNU for invasive UTUC.
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Affiliation(s)
- Zaishang Li
- Department of Urology, Shenzhen People's Hospital, The Second Clinic Medical College of Jinan University 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, First Affiliated Hospital of Southern University of Science and Technology, 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, Shenzhen Engineering and Technology Center of minimally Invasive Urology, Shenzhen People's Hospital, 518060, Shenzhen, Guangdong, P. R. China
| | - Xueying Li
- Department of Oncology, The Seventh Affiliated Hospital Sun Yat-sen University, 518107, Shenzhen, Guangdong, P. R. China
| | - Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, Guangdong, P. R. China.,State Key Laboratory of Oncology in South China, 510060, Guangzhou, Guangdong, P. R. China.,Collaborative Innovation Center of Cancer Medicine, 510060, Guangzhou, Guangdong, P. R. China
| | - Ying Liu
- Department of Urology, Shenzhen People's Hospital, The Second Clinic Medical College of Jinan University 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, First Affiliated Hospital of Southern University of Science and Technology, 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, Shenzhen Engineering and Technology Center of minimally Invasive Urology, Shenzhen People's Hospital, 518060, Shenzhen, Guangdong, P. R. China
| | - Peng Du
- Gynecology Department, Long-gang District Maternal and Child Healthcare Hospital, 518172, Shenzhen, Guangdong, P. R. China
| | - Zenqing Liu
- Department of Urology, Shenzhen People's Hospital, The Second Clinic Medical College of Jinan University 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, First Affiliated Hospital of Southern University of Science and Technology, 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, Shenzhen Engineering and Technology Center of minimally Invasive Urology, Shenzhen People's Hospital, 518060, Shenzhen, Guangdong, P. R. China
| | - Kefeng Xiao
- Department of Urology, Shenzhen People's Hospital, The Second Clinic Medical College of Jinan University 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, First Affiliated Hospital of Southern University of Science and Technology, 518060, Shenzhen, Guangdong, P. R. China.,Department of Urology, Shenzhen Engineering and Technology Center of minimally Invasive Urology, Shenzhen People's Hospital, 518060, Shenzhen, Guangdong, P. R. China
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Ryoo H, Kim J, Kim T, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Sung HH. Effects of Complete Bladder Cuff Removal on Oncological Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Cancer Res Treat 2020; 53:795-802. [PMID: 33421984 PMCID: PMC8291174 DOI: 10.4143/crt.2020.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/25/2020] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aimed to evaluate the effects of bladder cuff method on oncological outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Materials and Methods The records of 1,095 patients treated with RNU performed at our hospital between 1994 and 2018 were retrospectively reviewed; 856 patients with no bladder tumor history were enrolled in the present study. The management of bladder cuff was divided into two categories: extravesical ligation (EL) or transvesical resection (TR). Survival was analyzed using the Kaplan-Meier method and Cox regression analyses were performed to determine which factors were associated with intravesical recurrence (IVR)–free survival (IVRFS), cancer-specific survival (CSS), and overall survival (OS). Results The mean patient age was 64.8 years and the median follow-up was 37.7 months. Among the 865 patients, 477 (55.7%) underwent the TR and 379 (44.3%) the EL. Significantly higher IVRFS (p=0.001) and OS (p=0.013) were observed in the TR group. In multivariable analysis, IVR, CSS, and OS were independently associated with the EL. Among 379 patients treated with the EL, eight underwent remnant ureterectomy. Based on radical cystectomy–free survival, significant difference was not observed between the two groups. However, significantly higher IVRFS was observed in the TR group when the tumor was located in the renal pelvis. Conclusion Intramural complete excision of the distal ureter during RNU should be the gold standard approach compared with EL for the management of distal ureter in terms of oncological outcomes.
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Affiliation(s)
- Hyunsoo Ryoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungyu Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taejin Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Shigeta K, Matsumoto K, Takeda T, Hattori S, Kaneko G, Matsushima M, Abe T, Tanaka N, Mizuno R, Asanuma H, Kikuchi E, Oya M. Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching. Ann Surg Oncol 2020; 28:465-473. [PMID: 32840743 DOI: 10.1245/s10434-020-09046-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. METHODS Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes. RESULTS Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR. CONCLUSION Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Hattori
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Gou Kaneko
- Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Takayuki Abe
- Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Braun AE, Srivastava A, Maffucci F, Kutikov A. Controversies in management of the bladder cuff at nephroureterectomy. Transl Androl Urol 2020; 9:1868-1880. [PMID: 32944551 PMCID: PMC7475677 DOI: 10.21037/tau.2020.01.17] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for roughly 5% of urothelial carcinomas. Historically, the gold standard for high-risk or bulky low-risk UTUC was an open radical nephroureterectomy with formal bladder cuff excision (BCE). The development of novel endoscopic, laparoscopic, and robotic techniques has transformed this operation, yet no level I evidence exists at present that demonstrates the superiority of one strategy over another. While new approaches to nephroureterectomy in the last decade have shifted the management paradigm to decrease the morbidity of surgery, controversy continues to surround the approach to the distal ureter and bladder cuff. Debate continues within the urologic community over which surgical approach is best when managing UTUC and how various approaches impact clinical outcomes such as intravesical recurrence, recurrence-free survival (RFS) and disease-specific mortality (DSM). When focusing on the existing treatment algorithm, key metrics of quality include (I) removal of the entire specimen en bloc, (II) minimizing the risk of tumor and urine spillage, (III) R0 resection, and (IV) water-tight closure allowing for early use of prophylactic intravesical chemotherapy. In the absence of robust evidence demonstrating a single superior approach, the urologic surgeon should base decisions on technical comfort and each patient's particular clinical circumstance.
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Affiliation(s)
- Avery E Braun
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Abhishek Srivastava
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Fenizia Maffucci
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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Pathak RA, Hemal AK. Fate of residual ureteral stump in patients undergoing robot-assisted radical nephroureterectomy for high-risk upper tract urothelial carcinoma. Transl Androl Urol 2020; 9:856-862. [PMID: 32420200 PMCID: PMC7214963 DOI: 10.21037/tau.2019.09.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Management of the distal ureter in radical nephroureterectomy and bladder cuff excision (RNUBCE) is paramount, directly influencing oncologic outcomes. Herein, we analyze the natural history of patients who have undergone robotic radical nephroureterectomy without formal bladder cuff excision and retained ureteral stump and compare this cohort with patients undergoing formal RNUBCE for high-risk upper tract urothelial carcinoma (UTUC). Methods From February 2008 to October 2018, all patients who underwent robotic RNUBCE by multiple surgeons in a single institution for high-risk UTUC were reviewed. Preoperative, perioperative, and postoperative variables were investigated. Overall survival, cancer specific survival, local recurrence-free survival, distant recurrence-free survival, and bladder recurrence-free survival were compared between the two cohorts. Further management treatments were explored for patients with retained ureteral stump. Follow-up consisted of abdominopelvic/chest imaging and cystoscopy at regular intervals. Results A total of 105 patients underwent robotic RNU during the above time period. Of patients with documented 6-month follow-up, approximately 6.6% of patients had retained ureteral stump. Median follow-up for the entire cohort was 31.5 months with a range of 6 to 114.2 months. Factors that precluded formal BCE were densely, fibrotic reaction near the ureterovesical junction due to prior vascular or pelvic surgery in 5 patients, severe pyonephrosis and continued anesthetic risk in one patient, and surgeon choice (patient co-morbidities) in another patient. Three patients died with metastatic disease and one patient succumbed to cardiovascular compromise. Two additional patients developed local recurrence only at the level of the ureteral stump, with one patient undergoing eventual distal excision, contralateral RNUBCE and radical cystectomy. Conclusions In these cases, responsibilities assumed by the surgeon demand the utmost in judgement and skill; however, at times, circumstances prevail such as patient factors and nature/biology of the disease. These factors may prevent adequate excision the complete ureter, ureterovesical junction, and bladder cuff at the time of RNU. In this robotic cohort of patients undergoing RNUBCE for UTUC, not excising the most distal part of the ureter directly translates to inferior oncologic outcomes. Complete ureteral excision with bladder cuff should be performed where possible as this is an integral part of the radical nephroureterectomy. Also, if feasible, adjunctive chemotherapy/immunotherapy treatments should be considered.
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Affiliation(s)
- Ram A Pathak
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
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Zhang L, Wu B, Zha Z, Zhao H, Yuan J, Feng Y. The Prognostic Value of Lymphovascular Invasion in Patients With Upper Tract Urinary Carcinoma After Surgery: An Updated Systematic Review and Meta-Analysis. Front Oncol 2020; 10:487. [PMID: 32391257 PMCID: PMC7189418 DOI: 10.3389/fonc.2020.00487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/18/2020] [Indexed: 01/11/2023] Open
Abstract
Background and Purpose: Although the prognostic value of lymphovascular invasion (LVI) for upper tract urinary carcinoma (UTUC) has been reported, there is a lack of consensus regarding the prognostic factor of LVI in UTUC after radical nephroureterectomy (RNU). The aim of the present study was to evaluate the contemporary role of LVI using systematic review and meta-analysis. Materials and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic search of Web of Science, PubMed, and EMBASE for all reports published up to July 2019. Cumulative analyses of hazard ratios (HRs)/odds ratios (ORs) and their corresponding 95% confidence intervals were conducted to assess the association between LVI and oncological outcomes and clinicopathological features. Results: Our meta-analysis included 31 eligible studies containing 14,653 patients with UTUC (81–1,363 per study). Our results indicated a significant correlation of LVI with worse cancer-specific survival (HR = 1.59, p < 0.001), overall survival (HR = 1.55, p < 0.001), recurrence-free survival (HR = 1.46, p < 0.001), cancer-specific mortality (HR = 1.25, p = 0.047), and recurrence (HR = 1.23, p = 0.026). LVI was also correlated with advanced tumor stage (III/IV vs. I/II: OR = 7.63, p < 0.001), higher tumor grade (3 vs. 1/2: OR = 5.61, p < 0.001), lymph node metastasis (yes vs. no: OR = 4.95, p < 0.001), carcinoma in situ (yes vs. no: OR = 1.92, p < 0.001), and positive surgical margin (yes vs. no: OR = 4.38, p < 0.001), but not related to gender (male vs. female: OR = 0.98, p = 0.825), and multifocality (multifocal vs. unifocal: OR = 1.09, p = 0.555). The funnel plot test indicated no significant publication bias. Conclusions: This study demonstrated that LVI was associated with aggressive clinicopathological features. LVI may serve as a poor prognostic factor for patients with UTUC after RNU.
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Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Yejun Feng
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
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11
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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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12
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Tumor Multifocality is a Significant Risk Factor of Urinary Bladder Recurrence after Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma: A Single-Institutional Study. Diagnostics (Basel) 2020; 10:diagnostics10040201. [PMID: 32260187 PMCID: PMC7235732 DOI: 10.3390/diagnostics10040201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to identify the significant risk factors of urinary bladder recurrence (UBR) after nephroureterectomy (NUx) in patients with upper tract urothelial carcinoma (UTUC). A total of 550 patients diagnosed with UTUC between January 2001 and December 2015 were included in this retrospective study. The median age of our patients was 68 (range 24–93) and the median follow-up time after NUx was 40.3 months (range 8–191). The most important censored point of this study was the first episode of UBR. Of the 550 patients, UBR occurred in 164 patients (29.8%). One hundred and forty-two (86.6%) patients with UBR were identified within two years after NUx for UTUC, with the median time interval between NUx and UBR being 8.4 months (range 3–59.8). Through univariate analysis, the positive surgical margin (p = 0.049) and tumor multifocality (p = 0.024) were both significant prognostic factors for UBR-free survival after NUx in patients with UTUC. However, only tumor multifocality (p = 0.037) remained a significant prognostic factor by multivariate analysis. In conclusion, tumor multifocality is a significant risk factor of UBR after nephroureterectomy in patients with upper tract urothelial carcinoma.
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13
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Assessing the impact of different distal ureter management techniques during radical nephroureterectomy for primary upper urinary tract urothelial carcinoma on oncological outcomes: A systematic review and meta-analysis. Int J Surg 2020; 75:165-173. [PMID: 31978650 DOI: 10.1016/j.ijsu.2020.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the oncological outcomes of several distal ureter management techniques in patients administered with radical nephroureterectomy (RNU) for primary upper urinary tract urothelial carcinoma (UTUC). METHODS A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing outcomes following RNU under various surgical methods for bladder cuff management. Standard cumulative analyses of hazard ratios (HRs) with 95% confidence intervals (CIs) were performed using Review Manager (5.3). RESULTS Nine studies involving 4683 patients were selected based upon eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences among intravesical incision of the bladder cuff (IVBC), extravesical incision of the bladder cuff (EVBC) and transurethral incision of the bladder cuff (TUBC) techniques. However, the IVBC technique appeared to have better recurrence-free survival (RFS) (HR = 1.37, p < 0.01) and intravesical recurrence-free survival (IRFS) (HR = 1.45, p < 0.01) compared with non-IVBC methods, including both TUBC and EVBC. When studies involving patients with bladder tumour history were excluded, the pooled statistic appeared to confirm that IVBC was associated with improved IRFS (HR = 1.25, p = 0.03) compared with EVBC and TUBC. No significant difference was found between the EVBC and TUBC groups (HR = 1.81, p = 0.32). CONCLUSIONS The findings suggest that IVBC is associated with improved oncologic outcomes and that it may be recommended for distal ureter management. However, caution must be taken because this recommendation is based upon a very limited number of clinical studies. Further research with enhanced outcome data collection and improved reporting is required to confirm these findings.
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14
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Carrion A, Ribal MJ, Morote J, Huguet J, Raventós C, Lozano F, Costa-Grau M, Alcaraz A. A comparative study of different surgical techniques for the management of distal ureter during laparoscopic radical nephroureterectomy. Actas Urol Esp 2019; 43:543-550. [PMID: 31447089 DOI: 10.1016/j.acuro.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). MATERIAL AND METHODS Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007-2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). RESULTS A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3-120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (P=.961), distant/local recurrence (P=.955) nor CSS (P=.802). The open extravesical approach was not related to bladder recurrence (P=.12) but increased distant/local recurrence (P=.045) and decreased CSS (P=.034) compared to intravesical approach. CONCLUSIONS LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical.
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Affiliation(s)
- A Carrion
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - M J Ribal
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J Morote
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Huguet
- Departamento de Urología, Fundación Puigvert, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Raventós
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - F Lozano
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - M Costa-Grau
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - A Alcaraz
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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15
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Taylor J, Meng X, Ghandour R, Margulis V. Advancements in the clinical management of upper tract urothelial carcinoma. Expert Rev Anticancer Ther 2019; 19:1051-1060. [PMID: 31770492 DOI: 10.1080/14737140.2019.1698295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Upper tract urothelial carcinoma (UTUC) remains a complex disease to manage given challenges in staging, surgical resection, use of perioperative therapy, and prevention of bladder recurrences. High-level evidence is limited to guide management; however, recent data have shifted treatment paradigms. We intend to review recent evidence on advancements in the clinical management for UTUC.Areas covered: This review summarizes advancements in pre-operative work-up, surgical technique, and the use of intravesical and systemic therapy in both the neoadjuvant and adjuvant settings. Special comment is made on progress in the genomics of UTUC and how that can inform clinical practice.Expert opinion: Advancements in the clinical management of UTUC are most prominently being made in the neoadjuvant chemotherapy setting. Although level I evidence is sparse, data from both single and multi-institutional retrospective studies strongly encourage the use of neoadjuvant chemotherapy especially in high-risk or advanced-stage patients.
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Affiliation(s)
- Jacob Taylor
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rashed Ghandour
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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16
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Mistretta FA, Carrion DM, Nazzani S, Vásquez JL, Fiori C, De Cobelli O, Porpiglia F, Esperto F. Bladder recurrence of primary upper tract urinary carcinoma following nephroureterectomy, and risk of upper urinary tract recurrence after ureteral stent positioning in patients with primary bladder cancer. MINERVA UROL NEFROL 2019; 71:191-200. [PMID: 30654603 DOI: 10.23736/s0393-2249.19.03311-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Upper tract urinary carcinoma (UTUC) and bladder cancer (BCa) share similar biological, histological and pathological characteristics. These resemblances could explain the high rate of synchronous and metachronous tumors affecting both upper urinary tract and bladder. In patients affected by primary UTUC bladder recurrence is quite common and it represents one of the major concerns during the follow-up of patients who underwent radical nephroureterectomy. Conversely, UTUC recurrence after primary non-muscular invasive BCa is a relatively rare event. Moreover, there is no clear evidence on whether the use of Double-J stenting as drainage in patients affected by BCa increases the risk of UTUC recurrence. The aim of the current study was to summarize the most recent evidence regarding the bladder recurrence after UTUC surgical treatment, and the UTUC recurrence after stent positioning in patients affected by primary BCa.
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Affiliation(s)
- Francesco A Mistretta
- Department of Urology, European Institute of Oncology, Milan, Italy - .,European Society of Residents in Urology (ESRU), Brussels, Belgium -
| | - Diego M Carrion
- European Society of Residents in Urology (ESRU), Brussels, Belgium.,Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Sebastiano Nazzani
- Department of Urology, IRCCS San Donato Policlinic, University of Milan, Milan, Italy
| | - Juan L Vásquez
- European Society of Residents in Urology (ESRU), Brussels, Belgium.,Department of Urology, University Hospital of Zealand, Roskilde, Denmark.,Department of Urology, Copenhagen University Hospital, Herlev, Denmark
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Brussels, Belgium.,Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospital, Sheffield, UK
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17
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Comparison of Radical Nephroureterectomy and Partial Ureterectomy for the Treatment of Upper Tract Urothelial Carcinoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2793172. [PMID: 29854736 PMCID: PMC5944270 DOI: 10.1155/2018/2793172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 11/18/2022]
Abstract
This study aimed to compare the oncological and renal outcomes of partial ureterectomy (PU) versus radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). UTUC patients' clinical information was reviewed, and progression-free survival (PFS), overall survival (OS), and kidney function were collected. The mean follow-up period was 59 (6-135) months in the RNU group and 34.5 (5-135) months in the PU group. The mean operation time in the PU group was 141 (64-340) min, which is significantly shorter than the RNU group (P < 0.01). Regarding kidney function at one year or two years after operation, the PU group had significantly improved mean estimated glomerular filtration rate (eGFR) levels and a remarkably decreased constitution of patients with chronic kidney disease (CKD) III or higher group (P < 0.05). There was no significant difference in PFS and OS between the RNU group and the PU group (P > 0.05). Multifactor Cox regression analysis indicated that age and the preoperative CKD stages were independent risk factors for poor kidney functions of UTUC patients. Compared to patients in RNU group, patients in PU have no significant difference in survival time but have shorter operation time, shorter hospital stay, and improved kidney functions.
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18
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Bagrodia A, Kaffenberger S, Winer A, Murray K, Vacchio M, Zheng J, Ostrovnaya I, Bochner BH, Dalbagni G, Cha EK, Coleman JA. Timing of blood transfusion and oncologic outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2018; 36:645-653. [PMID: 29344681 DOI: 10.1007/s00345-018-2180-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To evaluate the impact of timing of blood transfusion in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). METHODS Outcomes of consecutive patients with UTUC treated with RNU were analyzed. Clinicopathologic factors were compared using Fisher's exact test or the Wilcoxon rank-sum test between patients who received any transfusion and no transfusion, and between patients receiving intraoperative transfusion only and patients receiving no transfusion. Cancer-specific and overall survival were estimated and multivariable analyses were performed to assess the impact of timing of transfusion on clinical outcomes. RESULTS Among 402 patients included in this study, 71 (17.6%) patients received a transfusion at any point and 27 (6.7%) patients received an intraoperative blood transfusion. Transfusion at any time, patient comorbidity, high grade, advanced stage, positive surgical margins, low preoperative hemoglobin, longer operative duration, and increased blood loss were significantly associated with cancer-specific survival (DSS) on univariable analysis (HR 1.85, 95% CI 1.20-2.85, p < 0.005). In the multivariable analysis, transfusion at any point was not a prognostic factor (HR 1.00, 95% CI 0.60-1.68, p = 0.99). When examining intraoperatively transfusion only, transfusion was significantly associated with DSS (HR 1.91, 95% CI 1.01-3.59, p = 0.045) but no longer significant in multivariable analysis (HR 0.72, 95% CI 0.32-1.65, p = 0.440). CONCLUSIONS Our study indicates that the administration of blood transfusion either intraoperatively or postoperatively is not associated with clinical or oncological outcomes in patients with upper tract urothelial carcinoma when adjusted for other factors in multivariable analysis. Further study is required.
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Affiliation(s)
- Aditya Bagrodia
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, J8.130, Dallas, TX, 75390-9110, USA.
| | - Samuel Kaffenberger
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Winer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie Murray
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Vacchio
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eugene K Cha
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Yao L, Yang K, Li X, Zhang Z, Zhang C, Gong K, Xi Z, He Z, Zhou L. Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer. World J Surg Oncol 2016; 14:171. [PMID: 27349891 PMCID: PMC4924241 DOI: 10.1186/s12957-016-0924-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center. Methods From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU. Results The patients’ characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p < 0.0001), the mean estimated blood loss (47.2 ± 82.4 versus 166.9 ± 250.9 ml, p = 0.002), and the mean hospital stay (6.1 ± 3.5 versus 8.1 ± 3.3 days, p = 0.03) of the CRNU group decreased significantly compared to the traditional group. The operative time was not affected by gender. No open conversion and major complications occurred. The surgical margin of the ureter was all negative. The mean follow-up time was 13.4 months for the CRNU group and 37.5 months for the TRNU group. All follow-up patients in the CRNU group were alive without local recurrence. No cases of port site metastasis and local recurrence were observed in both groups. Bladder tumor recurrence occurred in 4 patients of the CRNU group and 21 patients of the TRNU group. Conclusions The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.
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Affiliation(s)
- Lin Yao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Cuijian Zhang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhijun Xi
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
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20
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Carrion A, Huguet J, García-Cruz E, Izquierdo L, Mateu L, Musquera M, Ribal MJ, Alcaraz A. Intraoperative prognostic factors and atypical patterns of recurrence in patients with upper urinary tract urothelial carcinoma treated with laparoscopic radical nephroureterectomy. Scand J Urol 2016; 50:305-12. [DOI: 10.3109/21681805.2016.1144219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Albert Carrion
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Laura Izquierdo
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Mateu
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Maria José Ribal
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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21
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Seisen T, Granger B, Colin P, Léon P, Utard G, Renard-Penna R, Compérat E, Mozer P, Cussenot O, Shariat SF, Rouprêt M. A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma. Eur Urol 2015; 67:1122-1133. [DOI: 10.1016/j.eururo.2014.11.035] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/18/2014] [Indexed: 12/26/2022]
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22
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Neuzillet Y, Colin P, Phé V, Shariat S, Rouprêt M. Traitement chirurgical des tumeurs de la voie excrétrice supérieure par néphro-urétérectomie totale : état-de-l’art pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1021-9. [DOI: 10.1016/j.purol.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 06/27/2014] [Accepted: 07/16/2014] [Indexed: 01/18/2023]
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