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

James Peter Blackmur (Lead / Corresponding author), Etienne Chew, Matthew Trail, Katie Brodie, Nicola Santoni, Flora Rodger, David Hamilton, Fortis Gaba, Sophie Randall, Sarika Nalagatla, Brian Little, Khalid Janjua, Clare Sweeney, Andrew Martindale, Khaver Qureshi, Antony Riddick, Kevin O’Connor, S. Alan McNeill, Simon Phipps, Mark L. CutressEdward A. A. Mains, Ian Dunn, Sarah Reid, Grant D. Stewart, Gavin Lamb, Muhammad Zeeshan Aslam, Steve Leung, Ross Clark, Ian Wilson, Grenville Oades, Alexander Chapman, Alexander Laird

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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.

Original languageEnglish
Pages (from-to)757-765
Number of pages9
JournalWorld Journal of Urology
Volume41
Early online date24 Jan 2023
DOIs
Publication statusPublished - Mar 2023

Keywords

  • Nephroureterectomy
  • Recurrence-free survival
  • Surgical technique
  • Upper tract urothelial carcinoma
  • UTUC

ASJC Scopus subject areas

  • Urology

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