Distal Ureter Management During Nephroureterectomy: Evidence from a Systematic Review and Cumulative Analysis

Lee, Su‐Min; McKay, Alistair; Grimes, Nathan; Umez-Eronini, Nkem; Aboumarzouk, Omar

doi:10.1089/end.2018.0819

Cited by 15 publications

(15 citation statements)

References 65 publications

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“…18,19 Specifically, the difficulty in the operation lies in the management of the lower segment of the ureter and the opening part of the ureteral bladder. 20,21 For instance, separating the lower segment of the ureter easily causes bleeding, and it is difficult to suture the bladder because of the influence of the angled space. 22 Laparoscopic renal and ureteral surgeries, in which only an incision in the abdomen is required to open the ureter and bladder, thus remain the most prevalently used strategies.…”

Section: Discussionmentioning

confidence: 99%

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Wang

et al. 2020

J Int Med Res

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Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.

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Section: Discussionmentioning

confidence: 99%

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Wang

et al. 2020

J Int Med Res

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“…Total excision of the distal ureter with its intramural portion, the ipsilateral ureteral orifice, and bladder cuff is considered necessary for optimal management of UTUC [ 7 , 8 , 13 ]. Currently, several surgical approaches are used for the management of distal ureter during RNU [ 1 , 4 , 5 , 7 , 12 , 16 , 21 ]. Among the approaches, including intravesical and extravesical BCE, involve opening the bladder [ 5 , 7 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several BCE methods have been described [4,10], however, the optimal BCE method is unclear. Complete removal of intramural portion of distal ureter should be implemented although no specific method about BCE is recommended in the current guidelines [5,11]. Several groups have evaluated the effects of different distal ureter approaches on oncological outcomes [1,7,[12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Upper urinary tract urothelial carcinoma (UTUC) is a rare disease and accounts for 7%–8% of all renal tumors and 5% of all urothelial malignancies [ 1 – 3 ]. The carcinoma can arise from the urothelial cells of the renal calyces, renal pelvis, or ureter [ 4 ]; thus, the recurrence of bladder urothelial carcinoma is common, occurring in 15%–50% of patients after treatment [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Complete Bladder Cuff Removal on Oncological Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Ryoo

Kim

et al. 2021

Cancer Res Treat

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Purpose This study aimed to evaluate the effects of bladder cuff method on oncological outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Materials and MethodsThe records of 1,095 patients treated with RNU performed at our hospital between 1994 and 2018 were retrospectively reviewed; 856 patients with no bladder tumor history were enrolled in the present study. The management of bladder cuff was divided into two categories: extravesical ligation (EL) or transvesical resection (TR). Survival was analyzed using the Kaplan-Meier method and Cox regression analyses were performed to determine which factors were associated with intravesical recurrence (IVR)-free survival (IVRFS), cancer-specific survival (CSS), and overall survival (OS). ResultsThe mean patient age was 64.8 years and the median follow-up was 37.7 months. Among the 865 patients, 477 (55.7%) underwent the TR and 379 (44.3%) the EL. Significantly higher IVRFS (p=0.001) and OS (p=0.013) were observed in the TR group. In multivariable analysis, IVR, CSS, and OS were independently associated with the EL. Among 379 patients treated with the EL, eight underwent remnant ureterectomy. Based on radical cystectomy-free survival, significant difference was not observed between the two groups. However, significantly higher IVRFS was observed in the TR group when the tumor was located in the renal pelvis. ConclusionIntramural complete excision of the distal ureter during RNU should be the gold standard approach compared with EL for the management of distal ureter in terms of oncological outcomes.

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“…Laparoscopic NU (LNU) showed to offer lower surgical morbidity and shorter length of hospital stay, despite controversial findings about its oncological safety [3]. Equally, robotic NU (RNU) has been explored and increasingly implemented as robotic technology can facilitate key steps of the NU procedure, such as BCE and lymphadenectomy [3,4]. However, current literature still lacks robust evidence regarding RNU outcomes, as available data are mostly from small series or population-based studies [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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Purpose To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. Methods A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. Results Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI − 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. Conclusions Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined. Keywords Open radical nephroureterectomy • Hand-assisted radical nephroureterectomy • Laparoscopic radical nephroureterectomy • Robotic radical nephroureterectomy • Upper tract urothelial carcinoma Electronic supplementary material The online version of this article (

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Distal Ureter Management During Nephroureterectomy: Evidence from a Systematic Review and Cumulative Analysis

Cited by 15 publications

References 65 publications

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Effects of Complete Bladder Cuff Removal on Oncological Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

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