Abstract
Objective
To evaluate a single institution experience of total intracorporeal bladder cuffing
and distal ureterectomy (DUBC) in robotic radical nephrouretectomy (RNU) for upper
tract urothelial carcinoma (UTUC).
Materials and Methods
168 patients treated for UTUC with robotic RNU at our institution from May 2009 to
October 2019 were retrospectively analyzed. 92 patients underwent total intracorporeal
DUBC after robotic dock repositioning, whereas 76 patients underwent open methods
via Gibson incision. Perioperative outcomes including operation time, estimated blood
loss (EBL), transfusion rates, use of painkillers, Visual analogue scale (VAS) pain
scores, and complication rates were compared, as well as pathological and oncological
outcomes. Uni- and multi-variate Cox regression models were performed for survival
analysis.
Results
There were no significant differences in baseline patient characteristics between
the two groups. Patients who underwent intracorporeal bladder cuffing had less EBL
(169.8±150.4 vs 214.6±157.0, p=0.091) and decreased pain at 1 week (VAS score 1.18±1.1
vs. 2.2±1.1, p=0.017). Pathological outcomes were not significantly different, and
oncological outcomes including local and intravesical recurrence, cancer-specific
and overall mortality were comparable to patients who received extracorporeal bladder
cuffing. Intracorporeal bladder cuffing was not associated with increased risk of
progression on univariate analysis (HR 0.600, 95% CI 0.314-1.147; p=0.122).
Conclusion
Based on our experience, intracorporeal DUBC can be a safe and oncologically non-inferior
alternative method to RNU, with benefits of decreased EBL and postoperative pain.
Future prospective trials are necessary to further validate our results.
Keywords
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Article info
Publication history
Accepted:
September 18,
2022
Received:
July 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
None of the authors have any conflicts of interest with any institution or product.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
