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

TY - JOUR

T1 - Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma

T2 - retrospective analysis from the Scottish Renal Cancer Consortium

AU - Blackmur, James Peter

AU - Chew, Etienne

AU - Trail, Matthew

AU - Brodie, Katie

AU - Santoni, Nicola

AU - Rodger, Flora

AU - Hamilton, David

AU - Gaba, Fortis

AU - Randall, Sophie

AU - Nalagatla, Sarika

AU - Little, Brian

AU - Janjua, Khalid

AU - Sweeney, Clare

AU - Martindale, Andrew

AU - Qureshi, Khaver

AU - Riddick, Antony

AU - O’Connor, Kevin

AU - McNeill, S. Alan

AU - Phipps, Simon

AU - Cutress, Mark L.

AU - Mains, Edward A. A.

AU - Dunn, Ian

AU - Reid, Sarah

AU - Stewart, Grant D.

AU - Lamb, Gavin

AU - Aslam, Muhammad Zeeshan

AU - Leung, Steve

AU - Clark, Ross

AU - Wilson, Ian

AU - Oades, Grenville

AU - Chapman, Alexander

AU - Laird, Alexander

N1 - Copyright: © 2023, The Author(s).

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

KW - Nephroureterectomy

KW - Recurrence-free survival

KW - Surgical technique

KW - Upper tract urothelial carcinoma

KW - UTUC

UR - https://www.scopus.com/pages/publications/85146766872

U2 - 10.1007/s00345-023-04283-5

DO - 10.1007/s00345-023-04283-5

M3 - Article

C2 - 36692533

AN - SCOPUS:85146766872

SN - 0724-4983

VL - 41

SP - 757

EP - 765

JO - World Journal of Urology

JF - World Journal of Urology

ER -