Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach

Rodríguez, Joseph A.; Packiam, Vignesh T.; Boysen, William R.; Johnson, Scott; Smith, Zachary L.; Smith, Norm D.; Shalhav, Arieh L.; Steinberg, Gary D.

doi:10.1089/end.2017.0086

Cited by 57 publications

(38 citation statements)

References 17 publications

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“…This center effect is well illustrated by several studies reporting contradictory results. Two large US studies using data from the National Cancer Database between 2010 and 2013 [44,45]. A higher proportion of LND performed in patients operated by open or robot-assisted approaches than by a pure laparoscopic approach is noted (OR = 0.77 p <0.01).…”

Section: Results—evidence Synthesismentioning

confidence: 99%

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Duquesne

Ouzaïd

Loriot

et al. 2019

JCM

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Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.

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Section: Results—evidence Synthesismentioning

confidence: 99%

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Duquesne

Ouzaïd

Loriot

et al. 2019

JCM

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“…With increased operative skills and the demonstration of comparable oncologic outcomes, utilization of LNU has gradually increased. In the United States, utilization of LNU or robotic nephroureterectomy increased from 57.7% to 71.5% from 2010 to 2013, whereas use of ONU decreased from 42.3% to 28.6% [20].…”

Section: Discussionmentioning

confidence: 99%

The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study

et al. 2019

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“…Urothelial carcinoma of the upper urinary tract accounts for 5% of urothelial carcinomas, with estimated annual incidence of 1 to 2 cases per 100 000 persons 1 . Radical nephroureterectomy (RNU) with bladder cuff removal is the gold standard treatment of high‐risk tumors 2–5 and its use is increasing over time 6–8 . However, RNU is a surgical procedure that carries significant risk of complications.…”

Section: Introductionmentioning

confidence: 99%

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Rosiello

Palumbo

Deuker

et al. 2020

Journal of Surgical Oncology

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Background To investigate the effect of frailty on short‐term postoperative outcomes and total hospital charges (THCs) in patients with non‐metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). Methods Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000‐2015). We used the Johns Hopkins frailty‐indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. Results Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in‐hospital mortality (1.6% vs 1.0%), non‐home–based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in‐hospital mortality (OR, 1.52), non‐home–based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). Conclusion Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short‐term postoperative complications, as well as longer LOS and higher THCs after RNU.

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Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach

Abstract: RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

Cited by 57 publications

References 17 publications

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review

The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

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