Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma

European Urology
Evanguelos XylinasUpper Tract Urothelial Carcinoma Collaboration

Abstract

There is a lack of consensus regarding the optimal approach to the bladder cuff during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To compare the oncologic outcomes following RNU using three different methods of bladder cuff management. Retrospective analysis of 2681 patients treated with RNU for UTUC at 24 international institutions from 1987 to 2007. Three methods of bladder cuff excision were performed: transvesical, extravesical, and endoscopic. Univariable and multivariable models tested the effect of distal ureter management on intravesical recurrence, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Of the 2681 patients, 1811 (67.5%) underwent the transvesical approach; 785 (29.3%), the extravesical approach; and 85 (3.2%), the endoscopic approach. There was no difference in terms of RFS, CSS, and OS among the three distal ureteral management approaches. Patients who underwent the endoscopic approach were at significantly higher risk of intravesical recurrence compared with those who underwent the transvesical (p=0.02) or extravesical approaches (p=0.02); the latter two groups did not differ from each other (p=0.40). Actuarial intravesical RFS es...Continue Reading

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Citations

Sep 19, 2012·World Journal of Urology·Evanguelos XylinasShahrokh F Shariat
May 9, 2013·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Angela GillanGhulam Nabi
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Sep 15, 2020·Current Opinion in Urology·Dmitry EnikeevShahrokh Shariat
May 28, 2019·World Journal of Urology·Helene JungMarianne Brehmer

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