1
|
Ditonno F, Franco A, Veccia A, Bertolo R, Wu Z, Wang L, Abdollah F, Finati M, Simone G, Tuderti G, Helstrom E, Correa A, De Cobelli O, Ferro M, Porpiglia F, Amparore D, Tufano A, Perdonà S, Bhanvadia R, Margulis V, Brönimann S, Singla N, Puri D, Derweesh IH, Mendiola DF, Gonzalgo ML, Ben-David R, Mehrazin R, Moon SC, Rais-Bahrami S, Yong C, Sundaram CP, Moghaddam FS, Ghoreifi A, Djaladat H, Autorino R, Antonelli A. Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group). Urol Oncol 2024; 42:290.e1-290.e9. [PMID: 38760274 DOI: 10.1016/j.urolonc.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/11/2024] [Accepted: 04/20/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. MATERIALS AND METHODS In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. RESULTS Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. CONCLUSIONS The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.
Collapse
Affiliation(s)
- Francesco Ditonno
- University of Verona, Department of Urology, Verona, Italy; Rush University, Department of Urology, Chicago, IL
| | - Antonio Franco
- Rush University, Department of Urology, Chicago, IL; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | | | | | - Zhenjie Wu
- Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China
| | - Linhui Wang
- Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China
| | - Firas Abdollah
- Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI
| | - Marco Finati
- Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI
| | - Giuseppe Simone
- IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy
| | - Gabriele Tuderti
- IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy
| | - Emma Helstrom
- Fox Chase Cancer Center, Department of Urology, Philadelphia, PA
| | - Andres Correa
- Fox Chase Cancer Center, Department of Urology, Philadelphia, PA
| | | | - Matteo Ferro
- European Institute of Oncology IRCCS, Division of Urology, Milan, Italy
| | - Francesco Porpiglia
- University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy
| | - Daniele Amparore
- University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy
| | - Antonio Tufano
- Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy
| | - Sisto Perdonà
- Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy
| | - Raj Bhanvadia
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Vitaly Margulis
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Stephan Brönimann
- John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD
| | - Nirmish Singla
- John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD
| | - Dhruv Puri
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA
| | - Ithaar H Derweesh
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA
| | - Dinno F Mendiola
- University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL
| | - Mark L Gonzalgo
- University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL
| | - Reuben Ben-David
- Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY
| | - Sol C Moon
- Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL
| | - Courtney Yong
- Indiana University, Department of Urology, Indianapolis, IN
| | | | - Farshad Sheybaee Moghaddam
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
| | - Alireza Ghoreifi
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
| | | | | |
Collapse
|
2
|
Refugia JM, Thakker PU, O'Rourke TK, Cohen A, Bradshaw A, Casals R, Sandberg M, Whitman W, Saini S, Hemal AK. Adoption of robot-assisted radical nephroureterectomy permits a minimally invasive option for management of upper tract urothelial carcinoma in geriatric patients: comparison with non-geriatric patients with intermediate-term oncologic follow-up. J Robot Surg 2024; 18:257. [PMID: 38896165 PMCID: PMC11186893 DOI: 10.1007/s11701-024-02013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
To assess the oncologic efficacy and safety of robot-assisted approach to radical nephroureterectomy (RARNU) in geriatric versus younger patients with upper tract urothelial carcinoma (UTUC). A single-center, retrospective cohort study was conducted from 2009 to 2022 of 145 patients (two cohorts: < 75 and ≥ 75 years old) with non-metastatic UTUC who underwent RARNU. Primary endpoint was UTUC-related recurrence of disease during surveillance (bladder-specific and metastatic). Safety was assessed according to 30-day, modified Clavien-Dindo (CD) classifications (Major: C.D. III-V). Survival estimates were performed using Kaplan-Meier method. There were 89 patients < 75 years (median 65 years) and 56 patients ≥ 75 years (median 81 years). Comparing the young versus geriatric cohorts: median follow-up 38 vs 24 months (p = 0.03, respectively) with similar 3-year bladder-specific recurrence survival (60% vs 67%, HR 0.70, 95% CI [0.35, 1.40], p = 0.31) and metastasis-free survival (79% vs 70%, HR 0.71, 95% CI [0.30, 1.70], p = 0.44). Expectedly, the younger cohort had a significant deviation in overall survival compared to the geriatric cohort at 1-year (89% vs 76%) and 3-years (72% vs 41%; HR 3.29, 95% CI [1.88, 5.78], p < 0.01). The 30-day major (1% vs 0) and minor complications (8% vs 14%, p = 0.87). Limitations include retrospective study design of a high-volume, single-surgeon experience. Compared to younger patients with UTUC, geriatric patients undergoing RARNU have similar oncologic outcomes at intermediate-term follow-up with no increased risk of 30-day perioperative complications. Thus, age alone should not be used to disqualify patients from definitive surgical management of UTUC with RARNU.
Collapse
Affiliation(s)
- Justin M Refugia
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA.
| | - Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Timothy K O'Rourke
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Adam Cohen
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Aaron Bradshaw
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Randy Casals
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Maxwell Sandberg
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Wyatt Whitman
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Sumit Saini
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Ashok K Hemal
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| |
Collapse
|
3
|
Pokhrel G, Zheng H, Tao J, Cui J, Fan Y, Li Z, Dong B, Yu S, Zhang X. Assessing the Feasibility and Safety of the Toumai ® Robotic System in Urologic Surgery: Initial Experience. J Endourol 2024; 38:552-558. [PMID: 38468506 DOI: 10.1089/end.2024.0028] [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: 03/13/2024] Open
Abstract
Introduction: Robotic surgery using da Vinci surgical system has gained prominence in urology; emerging robotic platforms are expanding its applications and increasing affordability. We assess the feasibility and safety of a novel system, the Toumai® robotic system in various urological surgeries. Methods: This prospective study was conducted at the first affiliated hospital of Zhengzhou university. Twenty consecutive patients underwent renal and prostatic surgery with the Toumai. The study assessed technical feasibility (conversion rate) and safety (perioperative complications) of the procedures as primary outcomes. Secondary endpoints included key surgical perioperative outcomes: functional and oncologic results. The Endoscopic Surgical System operates within a master-slave protocol, comprising a Surgeon Console, Patient Platform, and Vision Platform. Results: Seventeen patients underwent various nephrectomy procedures and three underwent radical prostatectomy (RP). There was no conversion to alternative surgical approach; a single (Clavien-Dindo grade ≥3b) complication occurred, and no readmission was recorded within 30 days. The median operative time was 120, 140, and 210 minutes for partial nephrectomy (PN), radical nephrectomy, and RP, respectively. Off-clamp PN was performed in one case, and the warm ischemia time in the remaining two case was 18 minutes. The median docking time was 22 minutes for nephrectomy and 20 minutes for RP; no major robotic malfunction was encountered. At 3-month follow-up, no tumor recurrence was recorded, renal function was well preserved, and the continence status was satisfactory. Conclusions: We present the initial clinical utilization of an innovative robotic platform. Complex urological surgeries were successfully completed without conversions and with minimal complications. Further investigations are warranted to confirm these initial findings.
Collapse
Affiliation(s)
- Gaurab Pokhrel
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoke Zheng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Tao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinshan Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenhao Li
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
4
|
Shrivastava N, Bhargava P, Jain P, Choudhary GR, Jena R, Singh M, Navriya S, Madduri VKS, Bhirud DP, Sandhu AS. Robot-assisted ureteric reconstructive surgeries for benign diseases: Initial single-center experience with point of technique. Urologia 2024; 91:357-363. [PMID: 38345047 DOI: 10.1177/03915603241229144] [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: 05/31/2024]
Abstract
INTRODUCTION We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies. MATERIALS AND METHODS This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement. RESULTS A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months. CONCLUSION Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach.
Collapse
Affiliation(s)
- Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pritesh Jain
- Department of Urology, Preksha Hospital, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shivcharan Navriya
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
5
|
Zohar Y, Sivan B, Mintz I, Hefer B, Rouvinov K, Shani Shrem N, Mabjeesh NJ. Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney. J Pers Med 2024; 14:158. [PMID: 38392591 PMCID: PMC10890684 DOI: 10.3390/jpm14020158] [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: 12/12/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.
Collapse
Affiliation(s)
- Yarden Zohar
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Bezalel Sivan
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Ishai Mintz
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Ben Hefer
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Keren Rouvinov
- The Legacy Heritage Oncology Center, Dr. Larry Norton Institute, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Noa Shani Shrem
- The Legacy Heritage Oncology Center, Dr. Larry Norton Institute, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| | - Nicola J Mabjeesh
- Department of Urology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of Negev, P.O. Box 151, Be'er Sheva 84101, Israel
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Rajan K, Khalifa A, Geraghty R, Parmar K, KandaSwamy G, Gómez Rivas J, Somani B, Rai BP. Oncological Efficacy of Robotic Nephroureterectomy vs. Open and Laparoscopic Nephroureterectomy for Suspected Non-Metastatic UTUC-A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4926. [PMID: 37894293 PMCID: PMC10605607 DOI: 10.3390/cancers15204926] [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: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION AND AIMS The optimal approach for nephroureterectomy in patients with suspected UTUC remains a point of debate. In this review, we compare the oncological outcomes of robotic nephroureterectomy (RNU) with open (ONU) or laparoscopic nephroureterectomy (LNU). METHODS All randomized trials and observational studies comparing RNU with ONU and/or LNU for suspected non-metastatic UTUC are included in this review. The systematic review was performed in accordance with the Cochrane Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IV-RFS). The secondary outcome measures were the lymph node dissection (LND) rates, positive margin rates, and the proportion of patients receiving bladder intravesical chemotherapy. RESULTS We identified 8172 references through our electronic searches and 8 studies through manual searching. A total of 15 studies met the inclusion criteria. The total number of patients in the review was 18,964. RNU had superior OS compared to LNU (HR: 0.81 (95% CI: 0.71, 0.93), p-0.002 (very low certainty)). RNU and ONU had similar OS (HR: 0.83 (95% CI: 0.52, 1.34), p-0.44 (very low certainty)). One study reported an independent association of RNU as a worse predictor of IV-RFS when compared to ONU (HR-1.73 (95% CI: 1.22, 2.45)). The LND rates were higher in the RNU cohort when compared to the LNU cohort (RR 1.24 (95% CI: 1.03, 1.51), p-0.03 (low certainty)). The positive margin rate was lower in the RNU cohort when compared to the ONU cohort (RR 0.29 (95% CI: 0.08, 0.86), p-0.03 (low certainty)). CONCLUSION RNU offers comparable oncological efficacy to ONU, except for intravesical recurrence-free survival (IV-RFS). RNU has fewer positive surgical margin rates compared to ONU in well-balanced studies. RNU appears to outperform LNU for certain oncological parameters, such as OS and the proportion of patients who receive lymph node dissections. The quality of evidence comparing surgical techniques for UTUC has remained poor in the last decade.
Collapse
Affiliation(s)
- Karthik Rajan
- Department of Urology, Freeman Hospital, Newcastle NE7 7PJ, UK
| | - Ahmad Khalifa
- Department of Urology, Freeman Hospital, Newcastle NE7 7PJ, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle NE7 7PJ, UK
| | - Kalpesh Parmar
- Department of Urology, Freeman Hospital, Newcastle NE7 7PJ, UK
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | | |
Collapse
|
8
|
Li XR, Li KP, Zuo JL, Yang W, Tan H, Wang WY, Chen SY, Ma JH, Bao JS, Yue ZJ. Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis. J Robot Surg 2023; 17:1917-1931. [PMID: 37347357 DOI: 10.1007/s11701-023-01650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
The primary objective of the current study is to undertake a comparative analysis of the effectiveness and safety of minimally-invasive partial nephrectomy (MIPN; including laparoscopic and robotic approaches) and open partial nephrectomy (OPN) for the treatment of highly complex renal tumors (defined as PADUA or RENAL score ≥ 10). A comprehensive search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) to identify relevant studies published in the English language up to April 2023. The current study employed Review Manager 5.4 and encompassed controlled trials of both MIPN and OPN for the treatment of highly complex renal tumors. This study comprised a total of eight comparative trials involving 1161 patients. MIPN demonstrated a significant reduction in length of hospital stay (weighted mean difference [WMD] - 2.08 days, 95% confidence interval [CI] - 2.48, - 1.68; p < 0.00001), blood loss (WMD - 39.86 mL, 95% CI - 75.32, - 4.39; p = 0.03), transfusion rates (odds ratio [OR] 0.30, 95% CI 0.13, 0.71; p = 0.006), and overall complications (OR 0.46, 95% CI 0.31, 0.70; p = 0.0003). However, there were no significant differences between MIPN and OPN in terms of operative time, warm ischemia time, conversion to radical nephrectomy rates, renal functional and oncologic outcomes. This study reveals that MIPN presents several benefits in comparison to OPN, including decreased length of hospital stay, blood loss, transfusion rates, and complications, while still offering renal functional and oncological outcomes that are comparable to those of OPN in patients with highly complex renal tumors.
Collapse
Affiliation(s)
- Xiao-Ran Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Kun-Peng Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jia-le Zuo
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Hao Tan
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Wen-Yun Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Si-Yu Chen
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jun-Hai Ma
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
| | - Jun-Sheng Bao
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
| | - Zhong-Jin Yue
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
| |
Collapse
|
9
|
Hagimoto H, Kambe T, Mine Y, Kokubun H, Hattori Y, Abe Y, Kubota M, Tsutsumi N, Yamasaki T, Kawakita M. Necessity of prophylactic drainage tube in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy: A matched-pair analysis. Int J Urol 2023; 30:579-584. [PMID: 36951440 DOI: 10.1111/iju.15182] [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: 10/07/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To assess the necessity of prophylactic drain placement in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy for upper tract urothelial cancer. METHODS Between July 2011 and March 2021, 200 patients with localized clinical Tis-T3 upper urinary tract urothelial carcinoma underwent laparoscopic nephroureterectomy with open distal ureterectomy. After removing the specimen, drainage tubes were placed on the renal beds and/or in the retrovesical spaces. Drain tubes were omitted for most patients after 2017. We compared the postoperative outcomes between the patients with drain placement (D+ group) and without drain placement (D- group) using propensity score matching. RESULTS A total of 164 patients (90 in the D+ group and 74 in the D- group) were enrolled, and matched pairs of 108 patients were analyzed. There was no significant difference in the incidence of complications according to Clavien-Dindo grade in the two groups after the propensity score matching. There was no significant difference in the incidence of postoperative lymphocele (n = 5 vs. 9, p = 0.395) and symptomatic lymphocele (n = 1 vs. 1, p = 1) between the two groups. The length of hospital stay was significantly shorter in the D- group (11 vs. 8 days, p < 0.0001). CONCLUSIONS We found that omitting the drainage tube after laparoscopic radical nephroureterectomy did not increase postoperative complications or lymphocele and shortened the post-hospital stay.
Collapse
Affiliation(s)
- Hiroki Hagimoto
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takanari Kambe
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuta Mine
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidetoshi Kokubun
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuto Hattori
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yohei Abe
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naofumi Tsutsumi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
10
|
Morizane S, Stein H, Komiya T, Kaneta H, Takenaka A. Retroperitoneal robot-assisted laparoscopic nephroureterectomy using the da Vinci Xi and SP systems: Initial experiences in cadaveric models. Investig Clin Urol 2023; 64:380-387. [PMID: 37417563 DOI: 10.4111/icu.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To investigate the feasibility and optimal port placements of robot-assisted laparoscopic nephroureterectomy (RANU) via the retroperitoneal approach in the lateral decubitus and supine positions using the da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems. MATERIALS AND METHODS We performed lateral decubitus extraperitoneal RANU on the right side and supine extraperitoneal RANU on the left side using the DVXi and DVSP systems without repositioning in two fresh cadavers. In addition, paracaval and pelvic lymphadenectomies were performed simultaneously during both surgical procedures. The operative time of each procedure was calculated, and the technical details associated with these procedures were evaluated. RESULTS Lateral decubitus and supine extraperitoneal RANU using the DVXi and DVSP systems were achieved without repositioning. The surgeon console time ranged from 89 to 178 minutes, and no major technical complications were observed. However, carbon dioxide insufflation into the abdominal cavity was observed owing to a peritoneal breach during the creation of the surgical workspace, particularly in the supine position. Compared with the DVXi system, the DVSP system was more suitable for RANU using the retroperitoneal approach, except for renal handling. CONCLUSIONS The DVXi and DVSP systems are feasible for performing lateral decubitus and supine extraperitoneal RANU without patient repositioning. The lateral decubitus position may be better than the supine position, and the DVSP system is more suitable for retroperitoneal RANU than the DVXi system. Nevertheless, further studies should be performed in clinical settings to validate our results.
Collapse
Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Takayuki Komiya
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Hiroyuki Kaneta
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| |
Collapse
|
11
|
Peng L, Mehmud I, Meng C, Tang D, Li K, Gan L, Li J, Yi F, Li Y. ASO Author Reflections: Comparison of Perioperative Outcomes and Complications of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with Upper-Tract Urothelial Carcinoma. Ann Surg Oncol 2023; 30:3817-3818. [PMID: 37036589 DOI: 10.1245/s10434-023-13457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China
- South China Hospital, Health Science Center, The Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Irfan Mehmud
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China
- South China Hospital, Health Science Center, The Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Dongdong Tang
- South China Hospital, Health Science Center, The Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Kangsen Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Fulin Yi
- North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China.
| |
Collapse
|
12
|
Li KP, Wan S, Wang CY, Chen SY, Yang L. Perioperative, functional, and oncologic outcomes of robot-assisted versus open partial nephrectomy for complex renal tumors (RENAL score ≥ 7): an evidence-based analysis. J Robot Surg 2023:10.1007/s11701-023-01565-3. [PMID: 36913056 DOI: 10.1007/s11701-023-01565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
This study aims to assess the efficacy and safety of robot-assisted partial nephrectomy (RAPN) compared with open partial nephrectomy (OPN) in the management of complex renal tumors (defined as RENAL score ≥ 7). We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library to identify relevant comparative studies up to January 2023. This study was conducted with the Review Manager 5.4 software, and included RAPN and OPN-controlled trials for complex renal tumors. The prime outcomes were to assess the perioperative results, complications, renal function, and oncologic outcomes. A total of 1493 patients were included in seven studies. Compared to OPN, RAPN was associated with a significantly shorter hospital stay (weighted mean difference [WMD] - 1.53 days, 95% confidence interval [CI] - 2.44, - 0.62; p = 0.001), less blood loss (WMD - 95.88 mL, 95% CI - 144.19, - 47.56; p = 0.0001), lower transfusion rates (OR 0.33, 95% CI 0.15, 0.71; p = 0.005), fewer major complications (OR 0.63, 95% CI 0.39, 1.01; p = 0.05), and fewer overall complications (OR 0.49, 95% CI 0.36, 0.65; p < 0.00001). Nevertheless, no statistically significant differences were found between the two groups in operative time, warm ischemia time, estimated glomerular decline, intraoperative complications, positive surgical margins, local recurrence, overall survival, and recurrence-free survival. The study demonstrated that RAPN had superior perioperative parameters and fewer complications when compared to OPN for complex renal tumors. However, no significant differences were found in terms of renal function and oncologic outcomes.
Collapse
Affiliation(s)
- Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shun Wan
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Chen-Yang Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Si-Yu Chen
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
| |
Collapse
|
13
|
Comparison between robot-assisted versus open nephroureterectomy for upper tract urothelial carcinoma: outcomes from a pooled analysis. J Robot Surg 2023:10.1007/s11701-023-01551-9. [PMID: 36884204 DOI: 10.1007/s11701-023-01551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
The present study aimed to compare the efficacy and safety between robot-assisted nephroureterectomy (RANU) and open nephroureterectomy (ONU) for the treatment of upper tract urothelial carcinoma (UTUC). We systematically searched four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate pertinent studies published in English up to January 2023. The primary outcomes evaluated included perioperative results, complications, and oncologic outcomes. Statistical analyses and calculations were performed using Review Manager 5.4. The study was registered with PROSPERO (ID: CRD42022383035). In total, eight comparative trials, including 37,984 patients were enrolled. Compared to ONU, RANU was associated with a significantly shorter length of stay (weighted mean difference [WMD] - 1.63 days, 95% confidence interval [CI] - 2.90, - 0.35; p = 0.01), less blood loss (WMD - 107.04 mL, 95% CI - 204.97, - 9.11; p = 0.03), less major complication(OR 0.78, 95% CI 0.70, 0.88; p < 0.0001), and lower positive surgical margin (PSM) (OR 0.33, 95% CI 0.12, 0.92; p = 0.03). However, no statistically significant differences were observed between the two groups in operative time, transfusion rates, rate of lymph node dissection, lymph node yield, overall complications, overall survival, cancer-specific survival, recurrence-free survival, and progression-free survival. RANU has superior advantages compared to ONU in terms of length of hospital stay, blood loss, postoperative complications, and PSM, while providing comparable oncologic outcomes in patients with UTUC.
Collapse
|
14
|
Peng L, Mehmud I, Meng C, Tang D, Li K, Gan L, Li J, Yi F, Li Y. Comparison of Perioperative Outcomes and Complications of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with Upper-Tract Urothelial Carcinoma. Ann Surg Oncol 2023; 30:3805-3816. [PMID: 36879036 DOI: 10.1245/s10434-023-13221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND For medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients. METHODS A systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis. RESULTS Nine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] -1.10 to 59.92; p = 0.22), EBL (WMD -55.30, 95% CI -171.14 to 60.54; p = 0.13), LOS (WMD -0.39, 95% CI -1.03 to 0.25; p = 0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44-3.36; p = 0.17], or complications (OR 0.91, 95% CI 0.49-1.69; p = 0.13). CONCLUSION The meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.
Collapse
Affiliation(s)
- Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, China.,Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China.,Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Irfan Mehmud
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Dongdong Tang
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, China.,Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Kangsen Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Fulin Yi
- North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China.
| |
Collapse
|
15
|
Blackmur JP, Chew E, Trail M, Brodie K, Santoni N, Rodger F, Hamilton D, Gaba F, Randall S, Nalagatla S, Little B, Janjua K, Sweeney C, Martindale A, Qureshi K, Riddick A, O'Connor K, McNeill SA, Phipps S, Cutress ML, Mains EAA, Dunn I, Reid S, Stewart GD, Lamb G, Aslam MZ, Leung S, Clark R, Wilson I, Oades G, Chapman A, Laird A. Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium. World J Urol 2023; 41:757-765. [PMID: 36692533 PMCID: PMC10082697 DOI: 10.1007/s00345-023-04283-5] [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: 05/18/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Nephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC). METHODS Patients who underwent NU for UTUC across the SRCC 2012-2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan-Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS). RESULTS In 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan-Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS. CONCLUSION These data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.
Collapse
Affiliation(s)
- James Peter Blackmur
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
- Department of Urology, NHS Lothian, Edinburgh, UK.
| | - Etienne Chew
- Department of Urology, NHS Lothian, Edinburgh, UK
- College of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Flora Rodger
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | | | - Fortis Gaba
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sophie Randall
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
- College of Medicine, University of Glasgow, Glasgow, UK
| | | | - Brian Little
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | | | | | | | - Khaver Qureshi
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Antony Riddick
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin O'Connor
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Cork University Hospital, Cork, Republic of Ireland
| | | | - Simon Phipps
- Department of Urology, NHS Lothian, Edinburgh, UK
| | | | | | - Ian Dunn
- Department of Urology, NHS Lanarkshire, Airdrie, UK
| | - Sarah Reid
- Department of Urology, NHS Lanarkshire, Airdrie, UK
| | - Grant D Stewart
- Department of Urology, NHS Lothian, Edinburgh, UK
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Gavin Lamb
- Department of Urology, NHS Forth Valley, Larbert, UK
| | | | - Steve Leung
- Department of Urology, NHS Lothian, Edinburgh, UK
| | - Ross Clark
- Department of Urology, NHS Ayrshire and Arran, Ayr, UK
| | - Ian Wilson
- Department of Urology, NHS Highland, Inverness, UK
| | - Grenville Oades
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Alexander Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Urology, NHS Lothian, Edinburgh, UK
| |
Collapse
|
16
|
Zhang W, Pang Y, Cheng W, Wang T, Li Y, Li X, Zhang J, Xia X, Zheng Y, Zhang R, Tang J. Ex vivo coronary endothelial cell activation associated with indoor coal combustion initiated atherosclerosis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:160174. [PMID: 36379326 DOI: 10.1016/j.scitotenv.2022.160174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Plenty of rural populations still chronically exposed to indoor coal burning, which tremendously raises the risk of cardiovascular disease, in China. This study aimed to further investigate the association between indoor coal burning exposure and atherosclerotic cardiovascular diseases to search for relevant markers for disease prevention. Herein, we conducted a cross-sectional study, carried out on 752 local long-term residents with or without bituminous coal for cooking and heating indoor, in Nangong County, Hebei Province, China. We utilized a nearest neighbor propensity score match (PSM) with a caliper distance equal to 0.001 to eliminate bias caused by confounding factors. The expression of genes associated with endothelial activation (CCL2, CCL5, CXCL8, CXCL12, VCAM, ICAM, SELP) in primary human coronary artery endothelial cells (HCAECs) were quantified through ex vivo biosensor assay. Multiple linear regression models with stratification analyses by gender and binary logit regression models were used to evaluate the association between mRNA expression of biosensor genes and indoor coal burning pollution or carotid atherosclerosis, respectively. Protein secretion level was detected by enzyme-linked immunosorbent assay (ELISA). The prevalence of carotid atherosclerosis in exposure group was higher than control (P = 0.023), before PSM. The gene expression of CCL2 in exposure group was significantly higher than control (P = 0.002). Indoor coal burning exposure was correlated with gene expression of CCL2 (β = 3.45, 95 % CI: 0.04-6.87, P = 0.047) and CXCL8 (β = 1.25, 95 % CI: 0.02-2.49, P = 0.046) in female. A higher risk of carotid atherosclerosis was observed in the same as the increase expression of CCL2 (OR = 1.07, 95 % CI: 1.01-1.14, P = 0.020). In conclusion, prolonged exposure to indoor coal burning could elevate the gene expression of CCL2 by activating vascular endothelial cells and was relative to the initiation of carotid atherosclerosis.
Collapse
Affiliation(s)
- Wanjun Zhang
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Yaxian Pang
- Department of Toxicology, Hebei Medical University, Shijiazhuang 050017, People's Republic of China
| | - Wenting Cheng
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Tao Wang
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Yanting Li
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Xin Li
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Jianzhong Zhang
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Xiaowen Xia
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Yuxin Zheng
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China
| | - Rong Zhang
- Department of Toxicology, Hebei Medical University, Shijiazhuang 050017, People's Republic of China.
| | - Jinglong Tang
- Departmental of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao 266071, People's Republic of China.
| |
Collapse
|
17
|
O'Sullivan NJ, Naughton A, Temperley HC, Casey RG. Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis. BJUI COMPASS 2023; 4:246-255. [PMID: 37025468 PMCID: PMC10071076 DOI: 10.1002/bco2.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic-assisted (RANU) and laparoscopic nephroureterectomy (LNU). Methods A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta-analysis was performed using Review Manager 5. Results Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the robotic-assisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. Conclusion The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long-term outcomes, in particular recurrence, recurrence-free survival, overall survival and the correlation between surgical technique and survival.
Collapse
Affiliation(s)
- Niall J. O'Sullivan
- Department of Urology Tallaght University Hospital Dublin 24 Ireland
- School of Medicine Trinity College Dublin Dublin 2 Ireland
| | - Ailish Naughton
- Department of Urology St. Vincent's University Hospital Dublin 4 Ireland
| | | | - Rowan G. Casey
- Department of Urology Tallaght University Hospital Dublin 24 Ireland
- School of Medicine Trinity College Dublin Dublin 2 Ireland
| |
Collapse
|
18
|
Ibilibor C, Kennady EH, Greene KL. The role of surgery for locally advanced urothelial cancers. Curr Opin Urol 2022; 32:614-617. [PMID: 36081394 PMCID: PMC11188720 DOI: 10.1097/mou.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy. RECENT FINDINGS Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy. SUMMARY Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations.
Collapse
Affiliation(s)
- Christine Ibilibor
- University of Virginia, Department of Urology, Charlottesville, Virginia, USA
| | | | | |
Collapse
|
19
|
Neuzillet Y, Seisen T, Traxer O, Allory Y, Audenet F, Leon P, Loriot Y, Pradère B, Roumiguié M, Xylinas E, Masson-Lecomte A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Upper urinary tract urothelial cancer (UTUC). Prog Urol 2022; 32:1164-1194. [PMID: 36400481 DOI: 10.1016/j.purol.2022.08.003] [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: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC). METHODS A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0). CONCLUSION These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
Collapse
Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - Y Allory
- Service d'anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'urologie, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - Y Loriot
- Service d'oncologie médicale, Institut Gustave-Roussy, Villejuif, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - E Xylinas
- Service d'urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| |
Collapse
|
20
|
Han JH, Jeong SH, Kim SH, Yuk HD, Jeong CW, Kwak C, Ku JH. Increased urinary B2-microglobulin is associated with poor prognosis of upper tract urothelial carcinoma. Front Oncol 2022; 12:1008763. [PMID: 36303834 PMCID: PMC9593077 DOI: 10.3389/fonc.2022.1008763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Kidney tubular damage markers are biomarkers of acute or chronic kidney injury. Hypothetically, upper tract urothelial cancer (UTUC), which induces obstructive uropathy or direct invasion of the renal parenchyma, may also induce increased excretion of urinary tubular damage proteins. Therefore, this study aimed to investigate the use of tubular damage biomarker as prognostic markers for UTUC. Methods The records of 417 surgically resected patients with UTUC were obtained from the Seoul National University Prospectively Enrolled Registry for urothelial cancer-upper tract urothelial cancer (SUPER-UC-UTUC) between January 2016 and December 2020. Patients with non-urothelial cancer or without urinary tubular injury marker measurement were excluded, and finally, 296 patients were finally included. B2-microglobulin (B2-MG) was an injury marker, and a value higher than 0.3 was considered abnormally elevated, according to previous studies. Results The mean age was 70.9 years, and the male sex was predominant (n = 211, 71.3%). The incidences of renal pelvis and ureter cancer were similar (50.7% vs. 49.3%). Most patients had high-grade diseases (n = 254, 88.8%). The high urine B2-MG group was older, had decreased renal function, and had a higher pathologic T stage than did the low group. Multivariate Cox regression analysis of disease-free survival (DFS), open surgical method (Hazard ratio (HR) 1.52, p = 0.027), large tumor size (HR 1.06, p = 0.017), tumor multifocality (HR 1.90, p = 0.038), lymphovascular invasion (HR 2.19, p < 0.001), and high urine B2-MG (HR 1.57, p = 0.021) were significantly associated with shortened metastasis-free survival (MFS). Kaplan–Meier curve analysis revealed short DFS (median survival 15.5 months vs. unattained, log-rank p = 0.001) and MFS (unattained median survival in both groups, log-rank p = 0.003) for the high urine B2-MG group compared to the low urine B2-MG group. Conclusion Patients with UTUC presenting with increased pre-operative urine B2-MG levels were associated with disease recurrence and metastasis. This biomarker may aid in performing pre-operative risk stratification and in assessing the individual prognosis of patients with UTUC.
Collapse
Affiliation(s)
- Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Seung-hwan Jeong
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Si Hyun Kim
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Ja Hyeon Ku,
| |
Collapse
|
21
|
Ji R, He Z, Fang S, Yang W, Wei M, Dong J, Xu W, Ji Z. Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies. Front Oncol 2022; 12:964256. [PMID: 35992849 PMCID: PMC9382403 DOI: 10.3389/fonc.2022.964256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robot-assisted nephroureterectomy (RANU) and laparoscopic nephroureterectomy (LNU) are two minimally invasive surgical management for upper urinary tract urothelial carcinomas (UTUC). Though more high-tech, it remains largely unclear whether RANU provides additional benefits over LNU. We aimed to quantitatively compare the perioperative and oncologic outcomes between RANU and LNU. Methods The systematic review was performed based on a registered protocol (registration number CRD42022319086). We searched through PubMed, EMBASE and Cochrane databases, as well as conference proceedings and references of review articles (May 2022) for comparative studies reporting perioperative and oncologic outcomes independently in RANU and LNU groups. Selection of studies and data extraction were performed independently by two researchers. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Results of random-effects meta-analyses were presented as mean differences (MD) or Odds ratio (OR), as appropriate. Subgroup and univariate meta-regression analyses were performed to identify interstudy heterogeneities. Results The review included 8470 patients undergoing RANU and 19872 patients undergoing LNU from 12 comparative original studies. RANU was associated with fewer overall complications (OR=0.71, 95%CI: 0.62 to 0.81), longer operative time (MD=27.70, 95%CI: 0.83 to 54.60) and shorter length of stay (MD=-0.53, 95%CI: -0.98 to -0.07) compared to LNU. In addition, patients receiving RANU were more likely to have lymph node dissected (OR=2.61, 95%CI: 1.86 to 3.65). Recurrence and survival outcomes did not differ between two surgical procedures. Sample size, types of LNU and world region were major sources of heterogeneity. Conclusion For UTUC patients, RANU offers fewer complications and shorter hospitalization. However, RANU requires longer operative time and shares similar oncologic outcomes compared to LNU. Further randomized designed studies are warranted. Systematic Review Registration www.crd.york.ac.uk/prospero/, identifier CRD42022319086.
Collapse
Affiliation(s)
- Ruoyu Ji
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhangyuting He
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiyuan Fang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Yang
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Mengchao Wei
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
22
|
Saini S, Pathak RA, Hemal AK. Robotic nephroureterectomy in the management of upper tract urothelial cancer: inching toward standard of care? Int Urol Nephrol 2022; 54:1777-1785. [PMID: 35610528 DOI: 10.1007/s11255-022-03225-1] [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: 02/10/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
Abstract
Upper-tract urothelial carcinoma is a relatively rare malignancy. Current guidelines strongly recommend radical nephroureterectomy with bladder cuff excision and template-based lymph node dissection for all high-risk upper-tract urothelial carcinomas. Although the open approach is still considered the standard of care, evolution of minimally invasive approaches especially the robotic-assisted approach, has been found to be oncologically equivalent. Since its initial description in 2006, the surgical technique as well as the robotic surgical system has gone through a major evolution. With well-established advantages of the minimally invasive approach, robotic radical nephroureterectomy also has the ability to address both upper and lower urinary tract simultaneously without the need of patient repositioning, standardized single docking technique, ease of performing crucial steps like excision of ureterovesical junction and bladder cuff with watertight cystotomy closure, allowing perioperative instillation of intra-vesical chemotherapy. Robot-assisted radical nephro-ureterectomy and template-based lymph node dissection is gradually emerging as the current standard of care to achieve the best possible oncologic and functional outcomes. In this review article we are focusing on the evolution of this approach in the management of upper-tract urothelial carcinoma along with a review of oncologic outcomes.
Collapse
Affiliation(s)
- Sumit Saini
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ram Anil Pathak
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ashok Kumar Hemal
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
23
|
Stemrich RA, Patel NH, Baber JA, Ferretti MJ. Robot-Assisted Nephroureterectomy for Upper Tract Urothelial Carcinoma in a Patient with an Ileal Conduit. Case Rep Urol 2022; 2022:5321613. [PMID: 35573978 PMCID: PMC9095392 DOI: 10.1155/2022/5321613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Upper tract urothelial carcinoma remains an uncommon disease that is clinically difficult to identify early and surveil. Open nephroureterectomy is the gold standard for patients with high-grade disease, especially for patients in whom surveillance is complicated such as those with prior cystectomies/ileal conduits. This report presents a case of a patient with a history of radical cystectomy and ileal conduit construction who underwent a successful minimally invasive robotic surgery for treatment of upper tract urothelial carcinoma. Case Presentation. The patient is a 72-year-old Caucasian male with a history of recurrent superficial bladder tumors treated with cystoscopies with fulguration, Bacillus Calmette-Guerin, and a robot-assisted cystectomy with ileal conduit diversion presenting with recurrent urinary tract infections and hematuria secondary to a ureteral stricture. The patient was admitted previously for urosepsis during which time a percutaneous nephrostomy tube was inserted on the right side. Upon presentation, imaging revealed a lesion extending from the lower pole of the right kidney into the renal pelvis. The presence of a nephrostomy and urostomy allowed the surgical team to utilize a minimally invasive approach to remove the diseased kidney and ureter with visualization enhanced by indocyanine green. Conclusion Minimally invasive robot-assisted approaches to treating upper tract urothelial carcinomas may offer an alternative to the open cases typically employed in cases of patients with prior ileal conduit. Furthermore, utilizing indocyanine green may expand the applicability of such approaches to uro-oncologic cases with greater complexity.
Collapse
Affiliation(s)
| | - Neel Hasmukh Patel
- Geisinger, Urology Associate, 1000 E. Mountain Boulevard, Wilkes-Barre, PA 18702, USA
| | - Jacob A. Baber
- Geisinger, Urology Associate, 1000 E. Mountain Boulevard, Wilkes-Barre, PA 18702, USA
| | - Mark J. Ferretti
- Geisinger, Urology Associate, 1000 E. Mountain Boulevard, Wilkes-Barre, PA 18702, USA
| |
Collapse
|
24
|
Pathak RA, Hemal A. Editorial Comment on END-2021-0587-OR.R1. J Endourol 2022; 36:760-761. [PMID: 35172635 DOI: 10.1089/end.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ram A Pathak
- Wake Forest University School of Medicine, 12279, Medical Center BLVD, Winston-Salem, North Carolina, United States, 27101-4135.,Wake Forest University School of Medicine, 12279, Winston-Salem, United States, 27101-4135;
| | - Ashok Hemal
- Wake Forest University School of Medicine, 12279, Urology, Winston-Salem, North Carolina, United States.,Winston-Salem, United States;
| |
Collapse
|