Blackmur, J. P. et al. (2023) 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 Journal of Urology, 41(3), pp. 757-765. (doi: 10.1007/s00345-023-04283-5) (PMID:36692533) (PMCID:PMC10082697)
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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.
Item Type: | Articles |
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Keywords: | Recurrence-free survival, upper tract urothelial carcinoma, surgical technique, nephroureterectomy, UTUC. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Gaba, Dr Fortis |
Authors: | Blackmur, J. P., 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, S. A., Phipps, S., Cutress, M. L., Mains, E. A.A., Dunn, I., Reid, S., Stewart, G. D., Lamb, G., Aslam, M. Z., Leung, S., Clark, R., Wilson, I., Oades, G., Chapman, A., and Laird, A. |
College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
Journal Name: | World Journal of Urology |
Publisher: | Springer |
ISSN: | 0724-4983 |
ISSN (Online): | 1433-8726 |
Published Online: | 24 January 2023 |
Copyright Holders: | Copyright © 2023 The Authors |
First Published: | First published in World Journal of Urology 41(3): 757-765 |
Publisher Policy: | Reproduced under a Creative Commons License |
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