Objective
To compare the perioperative and oncologic outcomes associated with RCNU to a matched
cohort undergoing RC alone. Simultaneous radical cystectomy and nephroureterectomy
(RCNU) for synchronous upper tract and bladder urothelial carcinoma is an uncommon
procedure. Sparse literature exists comparing outcomes in patients treated with radical
cystectomy (RC) alone versus RCNU.
Methods
Adults treated with RCNU for urothelial carcinoma of the bladder (UCB) and upper tract
urothelial carcinoma (UTUC) between 1980 and 2020 were identified. Patients were matched
2:1 to patients undergoing RC alone for UCB based on age (+/- 5 years), gender, BMI
(+/- 5), Charlson Comorbidity Index, pathologic staging (stage ≤pT2 vs >pT2), and
receipt of neoadjuvant chemotherapy. Outcomes included overall survival (OS), recurrence
free survival (RFS), cancer specific survival (CSS), 30-day complications, length
of stay (LOS), operative time, and estimated blood loss (EBL).
Results
A total of 39 patients undergoing RCNU were identified and matched to 74 patients
undergoing RC. There were no significant differences in LOS, EBL, or 30-day complication
rates. Operative time was significantly longer in the RC cohort. OS (HR 0.58, CI 0.35-0.97,
P = .036) was significantly better for patients undergoing RC alone, while no significant
difference was noted in RFS (HR 0.65, 0.34-1.24) and CSS (HR 0.58, CI 0.31-1.08, P = .08).
Conclusions
Patients undergoing RCNU had significantly lower OS compared to a matched group of
patients undergoing RC alone. Perioperative outcomes between the groups did not differ
significantly. This data can inform patient counseling for treatment of this rare
disease state.
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Article info
Publication history
Published online: November 24, 2022
Accepted:
September 25,
2022
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding/Research support: None required.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
