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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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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.
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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
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Zhao Q, Wu L, Yang F, Chen D, Xing N. A Modified and Practical Surgical Technique for Pure Transperitoneal Laparoscopic Radical Nephroureterectomy in a Single Position and Research Outcomes. J Laparoendosc Adv Surg Tech A 2022. [PMID: 36577042 DOI: 10.1089/lap.2022.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: To explore the surgical techniques and clinical value of pure transperitoneal laparoscopic nephroureterectomy (LNU) plus bladder cuff excision (BCE) conducted without changing the patient's position in the treatment of upper tract urothelial carcinoma (UTUC). Methods: From August 2018 to July 2021, we retrospectively reviewed 66 patients who underwent LNU + BCE in a single position. Then, their demographic characteristics, perioperative and pathological outcomes, and postoperative follow-up data were evaluated. Results: All 66 operations in this group were successfully completed without conversion to open surgery. The mean operative time was 125 ± 47 minutes, whereas the estimated blood loss was 10 (10, 15) mL. The median postoperative drainage time was 4 (3.8, 6.0) days, the time to catheter extraction after the operation was 4.5 (3.0, 6.0) days, and the median postoperative hospital stay was 6 (5, 7) days. Pathological results showed urothelial carcinoma in 65 cases, including 56 high-grade and 9 low-grade cases. Lymph node metastasis was found in 8 cases of high-grade urothelial carcinoma. All the surgical margins were negative. The median follow-up was 16.5 (11.0-25.6) months, and there was neither tumor recurrence nor distant metastasis. Conclusions: Pure transperitoneal LNU + BCE in a single position is a safe and effective minimally invasive technique for UTUC and is worthy of clinical application and promotion. It takes advantage of a programmed procedure, short operation time, less blood loss, less trauma, and quick recovery after the operation. However, multicenter randomized controlled studies with large samples are needed to further confirm these findings. Trial Registration: The study was registered at Cancer Hospital, Chinese Academy of Medical Sciences (No. 22/054-3255) and the registration date is August 2018.
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Affiliation(s)
- Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyuan Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Chen
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Urology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China
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4
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König F, Shariat SF, Karakiewicz PI, Mun DH, Rink M, Pradere B. Quality indicators for the management of high-risk upper tract urothelial carcinoma requiring radical nephroureterectomy. Curr Opin Urol 2021; 31:291-296. [PMID: 33973537 DOI: 10.1097/mou.0000000000000895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article was to identify quality indicators for an optimized management of high-risk upper tract urothelial carcinoma (UTUC) requiring radical nephroureterectomy (RNU). RECENT FINDINGS RNU with bladder cuff resection is the standard treatment of high-risk UTUC. For the bladder cuff resection, two main approaches are accepted: transvesical and extravesical. Lymph node dissection following a dedicated template should be performed in all high-risk patients undergoing RNU as it improves tumour staging and possibly survival. Postoperative bladder instillation of single-dose chemotherapy should be administered after RNU to decrease the risk of intravesical tumour recurrence. Perioperative systemic chemotherapy should always be considered for advanced cancers. Although level-1 evidence is available for adjuvant platinum-based chemotherapy, neoadjuvant regimens are still being evaluated. SUMMARY Optimal management of high-risk UTUC requires evidence-based reproducible quality indicators in order to allow guidance and frameworks for clinical practices. Adherence to quality indicators allows for the measurement and comparison of outcomes that are likely to improve prognosis. Based on the literature, we found four evidence-based accepted quality indicators that are easily implementable to improve the management of high-risk UTUC patients treated with RNU: adequate management of the distal ureter/ bladder cuff, template-based lymph node dissection, single-shot postoperative intravesical chemotherapy, and perioperative systemic treatment.
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Affiliation(s)
- Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Dong-Ho Mun
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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5
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Wu G, Wang T, Wang J, Yuan H, Cui Y, Wu J. Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience. J Int Med Res 2021; 48:300060520973915. [PMID: 33233992 PMCID: PMC7705383 DOI: 10.1177/0300060520973915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.
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Affiliation(s)
- Gang Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jipeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hejia Yuan
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Veccia A, Carbonara U, Derweesh I, Mehrazin R, Porter J, Abdollah F, Mazzone E, Sundaram CP, Gonzalgo M, Mastroianni R, Ghoreifi A, Cacciamani GE, Patel D, Marcus J, Danno A, Steward J, Bhattu AS, Asghar A, Reese AC, Wu Z, Uzzo RG, Minervini A, Rha KH, Ferro M, Margulis V, Hampton LJ, Simone G, Eun DD, Djaladat H, Mottrie A, Autorino R. Single stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes. Minerva Urol Nephrol 2021; 74:233-241. [PMID: 33781022 DOI: 10.23736/s2724-6051.21.04247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RANU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU. METHODS Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTSː Overall, 148 patients were included in the analysis; 14% had an ECOG >1 and 68.2% ASA ≥3. Median tumor dimension was 3.0 (IQR:2.0-4.2) cm and 34.5% showed hydronephrosis at diagnosis. Forty-eight% were cT1 tumors. Bladder cuff excision and lymph node dissection were performed in 96% and 38.1% of the procedures, respectively. Median operative time and estimated blood loss were 215.5 (IQR:160.5-290.0) minutes and 100.0 (IQR: 50.0-150.0) mL, respectively. Approximately 56% of patients took opioids during hospital stay for a total morphine equivalent dose of 22.9 (IQR:16.0-60.0) milligrams equivalent. Postoperative complications were 26 (17.7%), with 4 major (15.4%). Seven patients underwent adjuvant chemotherapy, with median number of cycles of 4.0 (IQR:3.0-6.0). CONCLUSIONS Single stage Xi® RNU is a reproducible and safe minimally invasive procedure for treatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.
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Affiliation(s)
| | | | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Elio Mazzone
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alireza Ghoreifi
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Devin Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jamil Marcus
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Alyssa Danno
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - James Steward
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amit S Bhattu
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aeen Asghar
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adam C Reese
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Zhenjie Wu
- Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China
| | - Robert G Uzzo
- Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Koon H Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Hooman Djaladat
- Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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7
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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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