Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes: Results of a current series and a review of the literature

Laura Maria Krabbe, Mary E. Westerman, Aditya Bagrodia, Bishoy A. Gayed, Dina Khalil, Payal Kapur, Shahrokh F. Shariat, Ganesh Raj, Arthur I Sagalowsky, Jeffrey A Cadeddu, Yair Lotan, Vitaly Margulis

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Abstract

Objective: To evaluate the effect of distal ureter management on oncological outcomes in patients with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods and materials: Retrospective review of patient records and operative reports was conducted on 122 patients who underwent RNU. Data were compared between 2 groups using substratification by distal ureter management (transvesical bladder cuff [TVBC]) vs. no TVBC). Results: Mean patient age was 69.0 years and 63.1% were male. Median follow-up was 32.0 months. Most patients (n = 76, 62.3%) received a TVBC and 46 (37.7%) patients received no TVBC during RNU. There were no significant differences in clinicopathological variables between both groups except for a higher rate of lymphadenectomy during surgery in the TVBC group (38.2% vs. 15.2%). On multivariate analysis, intravesical recurrence (IVR) was not affected by distal ureter management but was affected by tumor multifocality (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.2-4.0; P = 0.013). However, non-IVR-free survival (non-IVR FS) and cancer-specific survival (CSS) were independently influenced by T stage (HR = 4.9; 95% CI, 1.5-16.3; P = 0.010 for non-IVR FS and HR = 6.3; 95% CI, 1.7-23.1; P = 0.005 for CSS) and management of the distal ureter (HR = 3.2; 95% CI, 1.3-7.6; P = 0.010 for non-IVR FS and HR = 3.4; 95% CI, 1.3-8.8; P = 0.010 for CSS). Conclusions: In our study, surgical management of the distal ureter without excision of a TVBC resulted in significantly worse non-IVR FS and CSS but had no influence on IVR. This is hypothesis generating and supports further prospective study as to standardization of BC resection during RNU.

Original languageEnglish (US)
Pages (from-to)54.e19-54.e26
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2014

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Ureter
Urinary Bladder
Survival
Confidence Intervals
Neoplasms
Recurrence
Lymph Node Excision
Multivariate Analysis
Prospective Studies
Carcinoma

Keywords

  • Nephroureterectomy
  • Prognosis
  • Surgical management
  • Upper tract
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{c2e9a8c763574035b42188d5866e4caa,
title = "Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes: Results of a current series and a review of the literature",
abstract = "Objective: To evaluate the effect of distal ureter management on oncological outcomes in patients with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods and materials: Retrospective review of patient records and operative reports was conducted on 122 patients who underwent RNU. Data were compared between 2 groups using substratification by distal ureter management (transvesical bladder cuff [TVBC]) vs. no TVBC). Results: Mean patient age was 69.0 years and 63.1{\%} were male. Median follow-up was 32.0 months. Most patients (n = 76, 62.3{\%}) received a TVBC and 46 (37.7{\%}) patients received no TVBC during RNU. There were no significant differences in clinicopathological variables between both groups except for a higher rate of lymphadenectomy during surgery in the TVBC group (38.2{\%} vs. 15.2{\%}). On multivariate analysis, intravesical recurrence (IVR) was not affected by distal ureter management but was affected by tumor multifocality (hazard ratio [HR] = 2.2; 95{\%} confidence interval [CI], 1.2-4.0; P = 0.013). However, non-IVR-free survival (non-IVR FS) and cancer-specific survival (CSS) were independently influenced by T stage (HR = 4.9; 95{\%} CI, 1.5-16.3; P = 0.010 for non-IVR FS and HR = 6.3; 95{\%} CI, 1.7-23.1; P = 0.005 for CSS) and management of the distal ureter (HR = 3.2; 95{\%} CI, 1.3-7.6; P = 0.010 for non-IVR FS and HR = 3.4; 95{\%} CI, 1.3-8.8; P = 0.010 for CSS). Conclusions: In our study, surgical management of the distal ureter without excision of a TVBC resulted in significantly worse non-IVR FS and CSS but had no influence on IVR. This is hypothesis generating and supports further prospective study as to standardization of BC resection during RNU.",
keywords = "Nephroureterectomy, Prognosis, Surgical management, Upper tract, Urothelial carcinoma",
author = "Krabbe, {Laura Maria} and Westerman, {Mary E.} and Aditya Bagrodia and Gayed, {Bishoy A.} and Dina Khalil and Payal Kapur and Shariat, {Shahrokh F.} and Ganesh Raj and Sagalowsky, {Arthur I} and Cadeddu, {Jeffrey A} and Yair Lotan and Vitaly Margulis",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2013.08.032",
language = "English (US)",
volume = "32",
pages = "54.e19--54.e26",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "1",

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TY - JOUR

T1 - Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes

T2 - Results of a current series and a review of the literature

AU - Krabbe, Laura Maria

AU - Westerman, Mary E.

AU - Bagrodia, Aditya

AU - Gayed, Bishoy A.

AU - Khalil, Dina

AU - Kapur, Payal

AU - Shariat, Shahrokh F.

AU - Raj, Ganesh

AU - Sagalowsky, Arthur I

AU - Cadeddu, Jeffrey A

AU - Lotan, Yair

AU - Margulis, Vitaly

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objective: To evaluate the effect of distal ureter management on oncological outcomes in patients with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods and materials: Retrospective review of patient records and operative reports was conducted on 122 patients who underwent RNU. Data were compared between 2 groups using substratification by distal ureter management (transvesical bladder cuff [TVBC]) vs. no TVBC). Results: Mean patient age was 69.0 years and 63.1% were male. Median follow-up was 32.0 months. Most patients (n = 76, 62.3%) received a TVBC and 46 (37.7%) patients received no TVBC during RNU. There were no significant differences in clinicopathological variables between both groups except for a higher rate of lymphadenectomy during surgery in the TVBC group (38.2% vs. 15.2%). On multivariate analysis, intravesical recurrence (IVR) was not affected by distal ureter management but was affected by tumor multifocality (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.2-4.0; P = 0.013). However, non-IVR-free survival (non-IVR FS) and cancer-specific survival (CSS) were independently influenced by T stage (HR = 4.9; 95% CI, 1.5-16.3; P = 0.010 for non-IVR FS and HR = 6.3; 95% CI, 1.7-23.1; P = 0.005 for CSS) and management of the distal ureter (HR = 3.2; 95% CI, 1.3-7.6; P = 0.010 for non-IVR FS and HR = 3.4; 95% CI, 1.3-8.8; P = 0.010 for CSS). Conclusions: In our study, surgical management of the distal ureter without excision of a TVBC resulted in significantly worse non-IVR FS and CSS but had no influence on IVR. This is hypothesis generating and supports further prospective study as to standardization of BC resection during RNU.

AB - Objective: To evaluate the effect of distal ureter management on oncological outcomes in patients with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Methods and materials: Retrospective review of patient records and operative reports was conducted on 122 patients who underwent RNU. Data were compared between 2 groups using substratification by distal ureter management (transvesical bladder cuff [TVBC]) vs. no TVBC). Results: Mean patient age was 69.0 years and 63.1% were male. Median follow-up was 32.0 months. Most patients (n = 76, 62.3%) received a TVBC and 46 (37.7%) patients received no TVBC during RNU. There were no significant differences in clinicopathological variables between both groups except for a higher rate of lymphadenectomy during surgery in the TVBC group (38.2% vs. 15.2%). On multivariate analysis, intravesical recurrence (IVR) was not affected by distal ureter management but was affected by tumor multifocality (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.2-4.0; P = 0.013). However, non-IVR-free survival (non-IVR FS) and cancer-specific survival (CSS) were independently influenced by T stage (HR = 4.9; 95% CI, 1.5-16.3; P = 0.010 for non-IVR FS and HR = 6.3; 95% CI, 1.7-23.1; P = 0.005 for CSS) and management of the distal ureter (HR = 3.2; 95% CI, 1.3-7.6; P = 0.010 for non-IVR FS and HR = 3.4; 95% CI, 1.3-8.8; P = 0.010 for CSS). Conclusions: In our study, surgical management of the distal ureter without excision of a TVBC resulted in significantly worse non-IVR FS and CSS but had no influence on IVR. This is hypothesis generating and supports further prospective study as to standardization of BC resection during RNU.

KW - Nephroureterectomy

KW - Prognosis

KW - Surgical management

KW - Upper tract

KW - Urothelial carcinoma

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U2 - 10.1016/j.urolonc.2013.08.032

DO - 10.1016/j.urolonc.2013.08.032

M3 - Article

C2 - 24360665

VL - 32

SP - 54.e19-54.e26

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

SN - 1078-1439

IS - 1

ER -