Bladder Recurrence Following Upper Tract Surgery for Urothelial Carcinoma: A Contemporary Review of Risk Factors and Management Strategies

Mertens, Laura S.; Sharma, Vidit; Matin, Surena F.; Boorjian, Stephen A.; Thompson, R. Houston; Masson-Lecomte, A.

doi:10.1016/j.euros.2023.01.004

Cited by 14 publications

(3 citation statements)

References 46 publications

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“…The occurrence of bladder recurrence after RNU is highly prevalent, thus emphasizing the necessity of routine cystoscopic surveillance, a recommendation prominently outlined in the NCCN guidelines ( 12 , 13 ). The high bladder recurrence rate can be attributed to potential factors such as tumor seeding and implantation.…”

Section: Discussionmentioning

confidence: 99%

Safety and oncological outcome of early intraoperative intravesicle mitomycin C vs. deferred instillation in patients receiving robot-assisted radical nephroureterectomy

Chou,

Lin,

Chang

et al. 2024

Front. Surg.

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IntroductionRadical nephroureterectomy with concurrent bladder cuff excision (RNUBCE) is the gold standard surgical approach for high-risk primary upper tract urothelial carcinoma (UTUC). Given the notably high incidence of bladder tumor recurrence following this procedure, this study aimed to evaluate the effect and safety of intraoperative mitomycin-C (MMC) instillation vs. deferred instillation on overall oncological outcomes following robot-assisted RNUBCE.MethodsThis is a retrospective chart review study. Patients with non-invasive (N0, not T3/T4) UTUC who underwent robotic RNUBCE combined an intraoperative MMC instillation or a deferred MMC instillation after surgery at a medical center in Taiwan between November 2013 and June 2020 were eligible for inclusion. Patients with prior bladder UC, carcinomas of other origins, received neoadjuvant chemotherapy, and had undergone kidney transplantation were excluded. All surgeries were executed by a single surgical team under the guidance of the same surgeon. The primary outcomes was the risk of bladder tumor recurrence between patients received intraoperative (IO) vs. deferred MMC instillation postoperatively (PO) during one-year follow-up. The secondary outcome was postoperative adverse events assessed by the Clavien–Dindo classification. Univariate and multivariable Cox regression analyses were performed to determine the associations between study variables and the outcomes.ResultsA total of 54 patients were included in the analysis. 12 (22.2%) patients experienced a bladder tumor recurrence during follow-up (IO: 7.7%, PO: 35.7%, p < 0.021). After adjustment in the multivariable, intraoperative MMC instillation was significantly associated with lower risk of bladder recurrence [adjusted hazard ratio (aHR) = 0.15, 95% CI: 0.03–0.81, p = 0.028]. No MMC-related Clavien–Dindo Grade III–IV adverse events were found in either group.ConclusionIIntraoperative MMC instillation is safe and associated with a lower bladder tumor recurrence risk in patients undergoing robotic RNUBCE for UTUC than deferred instillation. Future large, prospective studies are still warranted to confirm the findings.

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Section: Discussionmentioning

confidence: 99%

Safety and oncological outcome of early intraoperative intravesicle mitomycin C vs. deferred instillation in patients receiving robot-assisted radical nephroureterectomy

Chou,

Lin,

Chang

et al. 2024

Front. Surg.

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“…On the contrary, developing bladder cancer after a primary UTUC is reported to be approximately 15–50% ( 9 , 10 ). There are two theories that have been proposed as an explanation for the high rate of bladder recurrences: intraluminal seeding (epithelial migration) and in-field cancerization ( 2 , 11 ). As a result, it is difficult to establish if additional tumor sites are new primary “ de novo ” lesions or seeding sites from the original primary.…”

Section: Epidemiologymentioning

confidence: 99%

Advances in chemoablation in upper tract urothelial carcinoma: overview of indications and treatment patterns

Gottlieb,

Linehan,

Murray

2023

Transl Androl Urol

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Localized upper tract urothelial carcinoma (UTUC) is a difficult disease for clinicians to treat, due to the multitude of oncological and patient factors to consider. Despite the challenges of diagnostic staging, endoscopic management, and disease recurrence, there is still a need for local therapeutic options that do not subject patients to the morbidities of radical nephroureterectomy (RNU). Intraluminal chemotherapies have allowed for improved oncological control in patients with low-grade disease receiving renal-sparing treatment approaches. This narrative review discusses the treatment modalities available for localized low-grade UTUC, with a focus on the current status of chemoablation. The OLYMPUS trial was a pivotal study that lead to the Food and Drug Administration (FDA) approval of UGN-101 (mitomycin-C) in April 2020 for the treatment of low-grade UTUC, and intraluminal chemotherapy is now a widely used modality for managing this disease. The trial reported a complete response (CR) rate of 59%, and an estimated treatment durability of 82% at 1 year. However, a concern was the reported 44% ureteral stricture rate using the retrograde approach. More research is currently underway to determine the ideal instillation method for intraluminal therapies (e.g., retrograde vs. antegrade). Lastly, we discuss upcoming treatment options. Newer novel agents like padeliporfin vascular targeted photodynamic (VTP) therapy (brand name TOOKAD) are currently being studied, which will in hope provide additional treatment options for UTUC patients.

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“…There is a tendency toward equivalent clinical outcomes after laparoscopic or open surgery ( 3 , 4 ). Even after RNU, recurrence in the bladder occurs in 22–47% of UTUC patients ( 5 ), compared with 2–6% in the contralateral upper tract ( 6 ). Five-year cancer-specific survival (CSS) rates are only 50–80% ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Surgical techniques and oncological outcomes of pure transperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma

Yuan¹,

Xu²,

Li³

et al. 2023

Transl Androl Urol

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Background Open radical nephroureterectomy (RNU) with bladder cuff excision is the standard treatment for upper urinary tract urothelial carcinoma (UTUC). Traditional laparoscopic radical nephroureterectomy (LSRNU) is not minimally invasive enough due to the complex surgical procedure. This study aims to discuss the clinical feasibility and oncological outcomes of pure transperitoneal LSRNU for UTUC. Methods Between July 2010 and December 2020, 115 patients were admitted to the hospital with the diagnosis of UTUC treated with pure LSRNU by one surgeon. A special laparoscopic bulldog clamp was placed at the bladder cuff before cutting and suturing. The clinical and follow-up data were preoperatively collected and analyzed. Overall survival (OS) and cancer-specific survival (CSS) were estimated by the Kaplan-Meier method. Results All surgeries were completed uneventfully in this cohort. The mean operative time was 145.69 minutes. The mean estimated blood loss was 56.61 mL. The mean removal time of the drain was 3.46 days. The mean time of having liquid diet was 1.32 days, and the ambulation time was 1.50 days. All surgeries were effectively completed, and no case required open conversion. According to the Clavien-Dindo classification system, postoperative complications occurred in two patients (II, III). The mean length of postoperative hospital stay was 5.78 days. The mean follow-up duration was 54.50 months. Recurrence in the bladder was 16.0% (15/94), compared with 4.6% (4/87) in the contralateral upper tract. The 5-year OS and CSS rates were 78.9% and 81.4%, respectively. Conclusions Pure transperitoneal LSRNU is a safe and effective minimally invasive technology for the treatment of UTUC.

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Bladder Recurrence Following Upper Tract Surgery for Urothelial Carcinoma: A Contemporary Review of Risk Factors and Management Strategies

Cited by 14 publications

References 46 publications

Safety and oncological outcome of early intraoperative intravesicle mitomycin C vs. deferred instillation in patients receiving robot-assisted radical nephroureterectomy

Safety and oncological outcome of early intraoperative intravesicle mitomycin C vs. deferred instillation in patients receiving robot-assisted radical nephroureterectomy

Advances in chemoablation in upper tract urothelial carcinoma: overview of indications and treatment patterns

Surgical techniques and oncological outcomes of pure transperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma

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