Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Xylinas, Évanguelos; Rink, Michael; Eugene, K.; Clozel, Thomas; Lee, Richard K.; Fajković, Harun; Comploj, Evi; Novara, Giacomo; Margulis, Vitaly; Raman, Jay D.; Lotan, Yair; Kassouf, Wassim; Fritsche, Hans Martin; Weizer, Alon Z.; Martínez-Salamanca, Juan Ignacio; Matsumoto, Kazumasa; Zigeuner, Richard; Pycha, Armin; Scherr, Douglas S.; Seitz, Christian; Walton, Thomas J.; Trinh, Quoc Dien; Karakiewicz, Pierre I.; Matin, Surena F.; Montorsi, Francesco; Zerbib, Marc; Shariat, Shahrokh F.

doi:10.1016/j.eururo.2012.04.052

Cited by 221 publications

(159 citation statements)

References 27 publications

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“…Numerous smaller non-randomized retrospective studies have been published which do not demonstrate the superiority of any one of these techniques. 25,26 The lack of outcome differences between techniques other than those found by Xylinas and colleagues 19 may relate to the fact that other small studies would be underpowered and had limited follow-up. Additionally, large multicentered studies tend to include different techniques, which may reduce the confounding effect of an irreproducible novel technique used in a single centre.…”

Section: Discussionmentioning

confidence: 54%

“…A subsequent study from this collaboration incorporated endoscopic management of the distal ureter as a predictor of intravesical recurrence. 20 In their multi-institutional series of 773 patients that had overlapping data with Xylinas and colleauges, 19 Walton and colleagues 21 have also found endoscopic management to result in higher risks of tumour recurrence and cancer death on multivariable analysis. Ultimately, this large series generally corroborate our findings that a cystotomy with intravesical bladder cuff excision is required to ensure that the entire intramural ureter has been resected.…”

Section: Discussionmentioning

confidence: 99%

“…Distal ureter management during radical nephroureterectomy A number of prior studies have been published on this topic. The largest of these studies, published by Xylinas and colleagues, 19 is a multi-institutiona l study of 2681 patients with a median follow-up of 57.5 months. These authors had 1822 patients in their INTRAVESICAL group, 785 in their EXTRAVESICAL group and 85 in their ENDOSCOPIC group.…”

Section: Discussionmentioning

confidence: 99%

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The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Kapoor

Dason

Allard

et al. 2014

CUAJ

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Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database. Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed. Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease. Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Kapoor

Dason

Allard

et al. 2014

CUAJ

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“…Several studies have evaluated the risk factors for IVR after RNU, such as age, gender, tumor multiplicity, TNM stage, grade, tumor location, size, previous/concomitant bladder tumors, carcinoma in situ, surgical mode and distal ureter management (7,(15)(16)(17)(18)(19)(20)(21)(22). Among these factors, a history of a prior bladder tumor and a multifocal primary tumor are the most frequently reported, while others are still under debate.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic ureteroscopy for upper tract urothelial carcinoma is independently associated with intravesical recurrence after radical nephroureterectomy

Li¹,

Zhou²,

Su³

et al. 2017

European Urology Supplements

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“…31 Other prognostic variables following nephroureterectomy include lymphovascular invasion, concomitant carcinoma in situ (CIS), positive surgical margins, ureteral tumour location (as opposed to renal pelvis), previous or concomitant bladder tumours, tumour multifocality, and lack of postoperative intravesical mitomycin C instillation. 4,6,7,[10][11][12][14][15][16][17][18][19][21][22][23][24]26,[28][29][30][31][32][33][34][35][36][65][66][67][68][69] The rates of recurrence stratified by these variables are seldom reported.…”

Section: Prognostic Variablesmentioning

confidence: 99%

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

Kapoor¹,

Allard²,

Black³

et al. 2013

CUAJ

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Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Cited by 221 publications

References 27 publications

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Diagnostic ureteroscopy for upper tract urothelial carcinoma is independently associated with intravesical recurrence after radical nephroureterectomy

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

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