890 Critical Analysis of 30-Day Complications in a Cohort of Patients Undergoing Radical Nephroureterectomy

Lin, Ya; Deliere, Amanda; Lehman, Kathleen; Decter, Ross M.; Harpster, Lewis E.; Kaag, Matthew; Raman, Jay D.

doi:10.1016/j.juro.2013.02.463

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An Eastern Cooperative Oncology Group performance status ≥2 (OR, 3.9; p < 0.001) was an independent predictor for postoperative complications. [18] Another multicenter study reported a complication rate of 26% (46 of 177) after RNU, of which one-quarter were grade 3 or 4. [19] Therefore, the patient's age and preoperative performance status should be carefully considered when making decisions regarding cancer management and estimating survival benefit of treatment options.…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical management of upper tract urothelial cancer in octogenarians: A population-based study

Wang¹,

Phelan²,

Siddiqui

2024

Curr Urol

View full text Add to dashboard Cite

Background: Upper tract urothelial carcinoma (UTUC) is an aggressive disease with a high progression rate. The standardmanagement for this disease is nephroureterectomy. Nephron sparing nonradical surgery is an alternative therapeutic approach. In men with limited life expectancy, the potential harm of UTUC progression must be weighed against surgical morbidity and mortality, and thus, more conservative approaches may be selected. This study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized UTUC. Materials and methods: A search was conducted in the Surveillance, Epidemiology, and End Results database for patients older than 80 years who were diagnosed with localized (T1-2N0M0) cancer in the renal pelvis or ureter as the only malignancy from 2004 to 2015. Patients were divided into 3 therapeutic groups: no surgery, local intervention (ie, local tumor excision or segmented ureterectomy), and radical surgery (nephroureterectomy). Demographic and cancer-related parameter data were collected. Logistic regression analysis was conducted to investigate predictors for surgical treatment. Kaplan-Meier curves and Cox regression were used to analyze survival outcomes. Results: Data from 774 patients were analyzed, including 205 in the no-surgery group, 181 in the local intervention group, and 388 in the radical surgery group. Older, African American patients with T1 stage disease were less likely to receive surgical treatment. Among surgically treated patients, renal pelvic tumors, and high-grade and T2 stage disease were associated with radical resection. Surgically treated patients had a longer median overall survival (OS) than in those treated nonsurgically (13, 35, and 47 months in no-surgery, local intervention, and radical surgery groups, respectively; p < 0.001). Although surgically treated patients demonstrated higher 5-year OS (8.8% [no surgery], 23.2% [local intervention], and 23.5% [radical surgery], p < 0.001) and 5-year disease-specific survival (DSS) (41.0% [no surgery], 69.1%[local intervention], and 72.9%[radical surgery]; p < 0.001) than in those treated nonsurgically, no significant differences were found between the local intervention and radical surgery groups (p > 0.05). Based on multivariate Cox regression analysis, surgical treatments, including both nonradical and radical resection, were independently associated with improved OS and DSS after controlling for age, marital status, tumor grade, and radiation status. Conclusions: Patients older than 80 years with localized UTUC who undergo surgery demonstrate longer survival. Radical and nonradical resections seemto have similar OS and DSS outcomes. Thus, when clinically indicated in this population, a more conservative surgical approach may be reasonable.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of surgical management of upper tract urothelial cancer in octogenarians: A population-based study

Wang¹,

Phelan²,

Siddiqui

2024

Curr Urol

View full text Add to dashboard Cite

show abstract

“…This might rule out nephroureterectomy as the treatment of choice for patients with a solitary kidney, bilateral tumors, chronic renal failure, and those with a high surgical risk. In addition, radical nephroureterectomy has been associated with a significant complications rate of almost 10% major complications [6][7][8]. These considerations led to the development of kidney-sparing therapies, such as segmental ureterectomy and endoscopic treatments.…”

Section: Introductionmentioning

confidence: 99%

Strategies of Endoscopic Management of Upper Tract Urothelial Carcinoma among Endourologists: A Global Survey

Shvero

Carmona

Zilberman

et al. 2023

JPM

View full text Add to dashboard Cite

Up-to-date guidelines on the management of upper tract urothelial carcinoma (UTUC) are continuously published. We aim to assess the variability of diagnosis and treatment strategies in the endoscopic management of UTUC and adherence to European Association of Urology and National Comprehensive Cancer Network guidelines. A 15-question survey was designed to query practitioners on approaches to clinical practice and knowledge about endoscopic treatment indications and techniques. It was emailed to all members of the Endourologic Society through the society’s office, and to all Israeli non-member endourologists. Eighty-eight urologists participated in the survey. Adherence to guidelines on indications for endoscopic management was only 51%. Most of the survey respondents (87.5%) use holmium laser for tumor ablation, and ~50% use forceps for biopsy while the other half use baskets. Only 50% stated that they would use Jelmyto® for specific indications. Most (80%) indicated that they repeat the ureteroscopy 3 months after the first one, and 52.3% continue with follow-up ureteroscopy every 3 months during the first year after diagnosis. There is vast variability among endourologists in the technical aspects of UTUC, the indications for endoscopic management, and adherence to the available guidelines for managing UTUC.

show abstract

“…Upper tract urothelial carcinoma (UTUC) is uncommon, with an estimated incidence of 2/100 000 person-years [1]. The current standard of care for high-grade UTUC and low-grade UTUC that cannot be managed endoscopically is radical nephroureterectomy (RNU) [1], with potentially devastating effects on renal function [2,3]. Renal-sparing options, such as endoscopic tumour ablation or percutaneous resection, can achieve local control in the properly selected patient [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi‐institutional retrospective cohort study

et al. 2022

View full text Add to dashboard Cite

To assess the safety profile of antegrade mitomycin gel instillation through a percutaneous nephrostomy tube (PCNT) for upper tract urothelial carcinoma (UTUC) with the aim of decreasing morbidity associated with therapy. Patients and MethodsPatients undergoing antegrade administration of mitomycin gel via PCNT were retrospectively included for analysis from four tertiary referral centres between 2020 and 2022. The primary outcome was safety profile, as graded by Common Terminology Criteria for Adverse Events (v5.0). Post-therapy disease burden was assessed by primary disease evaluation (PDE) via ureteroscopy. ResultsThirty-two patients received at least one dose of mitomycin gel via PCNT for UTUC, 29 of whom completed induction and underwent PDE. Thirteen patients (41%) had residual tumour present prior to induction therapy. At a median of 15.0 months following first dose of induction therapy, ureteric stenosis occurred in three patients (9%), all of whom were treated without later recurrence or chronic stenosis. Other adverse events included fatigue (27%), flank pain (19%), urinary tract infection (12%), sepsis (8%) and haematuria (8%). No patients had impaired renal function during follow-up and there were no treatment-related deaths. Seventeen patients (59%) had no evidence of disease at PDE and have not experienced recurrence at a median follow-up of 13.0 months post induction. ConclusionsAdministration of mitomycin gel via a PCNT offers a low rate of ureteric stenosis, demonstrates a favourable safety profile, and is administered without general anaesthesia.

show abstract

890 Critical Analysis of 30-Day Complications in a Cohort of Patients Undergoing Radical Nephroureterectomy

Cited by 3 publications

References 0 publications

Impact of surgical management of upper tract urothelial cancer in octogenarians: A population-based study

Impact of surgical management of upper tract urothelial cancer in octogenarians: A population-based study

Strategies of Endoscopic Management of Upper Tract Urothelial Carcinoma among Endourologists: A Global Survey

Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi‐institutional retrospective cohort study

Contact Info

Product

Resources

About