The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry
Recommended Citation
Yong C, Slaven JE, Wu Z, Margulis V, Djaladat H, Antonelli A, Simone G, Bhanvadia R, Ghoreifi A, Moghaddam FS, Ditonno F, Tuderti G, Bronimann S, Dhanji S, Eilender B, Franco A, Finati M, Tozzi M, Helstrom E, Mendiola DF, Amparore D, Porpiglia F, Moon SC, Rais-Bahrami S, Derweesh I, Mehrazin R, Autorino R, Abdollah F, Ferro M, Correa A, Singla N, Gonzalgo ML, and Sundaram CP. The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry. Urol Oncol 2024.
Document Type
Article
Publication Date
11-1-2024
Publication Title
Urologic oncology
Abstract
OBJECTIVES: We sought to determine whether bladder cuff excision and its technique influence outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
METHODS AND MATERIALS: A multicenter, international, retrospective analysis using the ROBotic surgery for Upper tract Urothelial cancer Study (ROBUUST) 2.0 registry identified 1,718 patients undergoing RNU for UTUC between 2015 and 2023 at 17 centers across the United States, Europe, and Asia. Data was gathered on (1) whether bladder cuff excision was performed and (2) what technique was used, including formal excision or other techniques (pluck technique, stripping/intussusception technique) and outcomes. Multivariate and survival analyses were performed to compare the groups.
RESULTS: Most patients (90%, 1,540/1,718) underwent formal bladder cuff excision in accordance with EAU and AUA guidelines. Only 4% (68/1,718) underwent resection using other techniques, and 6% (110/1,718) did not have a bladder cuff excised. Median follow up for the cohort was 24 months (IQR 9-44). When comparing formal bladder cuff excision to other excision techniques, there were no differences in oncologic or survival outcomes including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis-free survival (MFS), overall survival (OS), or cancer-specific survival (CSS). However, excision of any kind conferred a decreased risk of bladder-specific recurrence compared to no excision. There was no difference in RFS, MFS, OS, or CSS when comparing bladder cuff excision, other techniques, and no excision.
CONCLUSIONS: Bladder cuff excision improves recurrence-free survival, particularly when considering bladder recurrence. This benefit is conferred regardless of technique, as long as the intramural ureter and ureteral orifice are excised. However, the benefit of bladder cuff excision on metastasis-free, overall, and cancer-specific survival is unclear.
Medical Subject Headings
Humans; Male; Female; Nephroureterectomy; Registries; Aged; Retrospective Studies; Carcinoma, Transitional Cell; Urinary Bladder; Middle Aged; Treatment Outcome; Kidney Neoplasms; Ureteral Neoplasms; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed ID
39112105
ePublication
ePub ahead of print
Volume
42
Issue
11
First Page
1
Last Page
373
