ABSTRACT
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=0.036) 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=0.08).
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.
Key Words
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REFERENCES
- Cancer Statistics, 2022.Ca Cancer J clin. 2022; 72: 7-33
- Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline.J Urol. 2016; 196: 1021-1029
- Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline.J Urol. 2017; 198: 552-559
- European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 Update.Eur Urol. 2018; 73: 111-122
- Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy.Eur Urol. 2015; 67: 376-401
Bochner BH, Dalbagni G, Sjoberg DD, et al: Comparing open radical cystectomy and robotassisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol; 67: 1042.
- Robot assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial.Lancet. 2018; 391: 2525
- Effect of hospital volume on 90-day mortality after radical cystectomy for bladder cancer in Spain.World J Urol. 2020; 38: 1221-1228
- A critical analysis of perioperative mortality from radical cystectomy.J Urol. 2006; 175: 886-889
- Validating the predictors of outcomes after radical cystectomy for bladder cancer.Cancer. 2019; 125: 223-231
- Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma.World J Urol. 2013; 31: 141-145
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Simultaneous laparoscopic nephroureterectomy and robot-assisted radical cystectomy: Lessons learned from our initial experience.Curr Urol. 2021; 15: 193-197
- Laparoscopic radical cystectomy and nephroureterectomy en bloc resection with lomboaortic and pelvic lymph node dissection.Med Pharm Rep. 2020; 93: 390-395
- Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy.BMC Urol. 2021; 21: 73
- Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series.Can Urol Assoc J. 2022; (Epub ahead of print)
- Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy.Eur Urol. 2018; 73: 363-371
- Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit?.Urology. 2005; 66: 299-304
- Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review.Int Braz J Urol. 2022; 48: 18-30
- Health-related quality of life in patients undergoing radical cystectomy with modified single stoma cutaneous ureterostomy, bilateral cutaneous ureterostomy and ileal conduit.Int Urol Nephrol. 2020; 52: 1683-1689
- Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy.BJU Int. 2016; 118: 521-526
- The effect of urinary diversion on long-term kidney function after cystectomy.Urol Oncol. 2020; 38 (e15-21): 796
- Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution.Eur Urol. 2012; 61: 491-497
- Immune Dysfunction and Risk of Infection in Chronic Kidney Disease.Adv Chronic Kidney Dis. 2019; 26: 8-15
- Significant predictors of contralateral upper tract recurrence after radical nephroureterectomy for upper tract urothelial carcinoma.Int J Urol. 2022; 29: 69-75
- Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer.Eur Urol Focus. 2019; 5: 224-241
- Lymph node dissection could bring survival benefits to patients diagnosed with clinically node-negative upper urinary tract urothelial cancer: a population-based, propensity score-matched study.Int J Clin Oncol. 2019; 24: 296-305
- Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma.Urol Oncol. 2018; 36 (9.e1-9)
- European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update.Eur Urol. 2021; 79: 62-79
Article Info
Publication History
Accepted:
September 25,
2022
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding/Research support: none required
Acknowledgements: None
Identification
Copyright
© 2022 Published by Elsevier Inc.
