TY - JOUR
T1 - The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma
T2 - An analysis of the ROBUUST 2.0 registry
AU - Yong, Courtney
AU - Slaven, James E.
AU - Wu, Zhenjie
AU - Margulis, Vitaly
AU - Djaladat, Hooman
AU - Antonelli, Alessandro
AU - Simone, Giuseppe
AU - Bhanvadia, Raj
AU - Ghoreifi, Alireza
AU - Moghaddam, Farshad Sheybaee
AU - Ditonno, Francesco
AU - Tuderti, Gabriele
AU - Bronimann, Stephan
AU - Dhanji, Sohail
AU - Eilender, Benjamin
AU - Franco, Antonio
AU - Finati, Marco
AU - Tozzi, Marco
AU - Helstrom, Emma
AU - Mendiola, Dinno F.
AU - Amparore, Daniele
AU - Porpiglia, Francesco
AU - Moon, Sol C.
AU - Rais-Bahrami, Soroush
AU - Derweesh, Ithaar
AU - Mehrazin, Reza
AU - Autorino, Riccardo
AU - Abdollah, Firas
AU - Ferro, Matteo
AU - Correa, Andres
AU - Singla, Nirmish
AU - Gonzalgo, Mark L.
AU - Sundaram, Chandru P.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Bladder cuff
KW - Nephroureterectomy
KW - Outcomes
KW - Upper tract urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85200770740&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2024.06.001
DO - 10.1016/j.urolonc.2024.06.001
M3 - Article
AN - SCOPUS:85200770740
SN - 1078-1439
VL - 42
SP - 373.e1-373.e7
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 11
ER -