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Thomas Flaig, MD


Surgical Strategies to Reduce Recurrence of Upper Tract Urothelial Carcinoma

By: Jenna Carter, PhD
Posted: Wednesday, August 30, 2023

A study published in the International Brazilian Journal of Urology explored the effects of different surgical strategies (such as combinations of radical nephroureterectomy and bladder cuff excision) on intravesical recurrence in patients with upper tract urothelial carcinoma. Eric Yi-Hsiu Huang, MD, PhD, of Taipei Veterans General Hospital, Taiwan, and colleagues found that a combination of minimally invasive radical nephroureterectomy and open bladder cuff excision was associated with significantly lower intravesical recurrence–free survival compared with the other combinations. Additionally, the overall survival rate was comparable across all groups tested.

“Radical nephroureterectomy with complete bladder cuff excision is the standard treatment for high-risk upper tract urothelial carcinoma…. Alternatively, several completely minimally invasive procedures have also been reported to be feasible and safe…. However, few studies have evaluated the oncological outcomes of the different combinations,” stated Dr. Huang and colleagues.

A total of 452 patients were included in this retrospective observational study. Patients underwent radical nephroureterectomy with bladder cuff excision between January 2010 and December 2020. The patients were classified into three groups based on the different combinations of surgical procedures: open radical nephroureterectomy with open bladder cuff excision (group 1, n = 104), minimally invasive radical nephroureterectomy with open bladder cuff excision (group 2, n = 196), and minimally invasive radical nephroureterectomy with intracorporeal bladder cuff excision (group 3, n = 152). Data on demographics, body mass index, medical history, and other variables were collected and used for multivariate Cox regression analyses to determine the impact of the surgical procedures on intravesical recurrence.

Findings revealed a comparable overall survival rate across the three groups tested. After 2.5 months of follow-up, the intravesical recurrence rate was 29.6%, and the intravesical recurrence–free survival rate was the lowest in group 2 (log-rank P = .048). Additionally, the multivariate analysis revealed that group 2 had a significantly higher risk of intravesical recurrence than group 1, and groups 1 and 3 had similar risks.

Disclosure: The study authors reported no conflicts of interest.

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