Nephroureterectomy with or without Bladder Cuff Excision for Localized Urothelial Carcinoma of the Renal Pelvis.

BACKGROUND: Few studies examined the rates of guideline implementation and the survival effect of bladder cuff excision (BCE) at nephroureterectomy (NU). OBJECTIVE: To assess the rates of guideline implementation regarding NU with BCE relative to NU without BCE in patients with upper tract urothelial carcinoma (UTUC) and to test the effect of BCE on cancer-specific (CSM) and other-cause mortality (OCM). DESIGN, SETTING, AND PARTICIPANTS: We relied on Surveillance, Epidemiology, and End Results database (2004-2014) for UTUC of the renal pelvis patients (T1-T3, N0, M0) treated with NU with or without BCE. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cumulative incidence plots relying on competing-risks methodology illustrated 5-yr CSM and OCM rates. Multivariable competing-risks regression (MCRR) models tested the effect of BCE versus no BCE at NU. RESULTS AND LIMITATIONS: Of 4266 assessable patients, 2913 (68.3%) underwent NU with BCE. Between 2004 and 2014, rates of BCE at NU increased from 63.0% to 74.5% (European Association for Palliative Care: 2%; p<0.001). At 60 mo, CSM rates were 19.7% versus 23.5% (p=0.005) in NU with BCE versus NU without BCE patients, respectively. In MCRR models, no difference in CSM was recorded according to BCE at NU (hazard ratio [HR]: 0.88, confidence interval [CI]: 0.75-1.03, p=0.1). Finally, OCM was unaffected by BCE at NU (HR: 0.94, CI: 0.77-1.15, p=0.5). This study is retrospective. CONCLUSIONS: According to guideline recommendation, the rates of NU with BCE increased over time. However, BCE status does not appear to affect CSM or OCM. Thus, our study was unable to examine the rates of urothelial cancer recurrence or metastatic progression according to BCE status. PATIENT SUMMARY: Rates of bladder cuff excision (BCE) at nephroureterectomy (NU) are increasing. This observation confirms improved adherence to guidelines over time. However, BCE status does not appear to affect survival after NU for upper tract urothelial carcinoma.

Techniques and Outcomes of Robot-assisted Nephro-ureterectomy for Upper Tract Urothelial Carcinoma.

Radical nephro-ureterectomy and bladder cuff excision (RNUBCE) is the gold standard treatment for upper tract urothelial carcinoma (UTUC). RNUBCE can be performed via an open, laparoscopic or robot-assisted approach. The primary objective of this narrative mini-review is to report the techniques and outcomes for robot-assisted RNUBCE in the published literature. Relevant articles were selected utilizing the following search categories: "robot nephro-ureterectomy", "robot-assisted nephro-ureterectomy", and "robot upper tract urothelial carcinoma". Different techniques in terms of patient positioning, port placement, lymph node dissection, and bladder cuff excision have been reported in the literature. Despite these varied techniques, perioperative outcomes of robot-assisted laparoscopic RNUBCE are favorable. In all, a total of 204 patients underwent RNUBCE, with a mean operating room time of 229.7min, mean blood loss of 189ml, and mean length of stay of 3.65 d. Further studies are needed to validate oncologic outcomes. PATIENT SUMMARY: Patients with high-risk upper tract urothelial carcinoma require complete removal of the kidney, ureter, and bladder cuff, along with a lymph node dissection. Although the procedure can be performed via an open approach, minimally-invasive surgery represents an alternative. Herein, we describe the techniques and outcomes of robot-assisted radical nephro-ureterectomy and bladder cuff excision.