Comparative Outcomes Following Endoscopic Ureteral Detachment and Formal Bladder Cuff Excision in Open Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma

Walton, Thomas J.; Sherwood, B.T.; Parkinson, Richard; Obakponovwe, O.; Thomas, Stephen; Taylor, Madeline; England, Roland; Lemberger, R. J.

doi:10.1016/j.juro.2008.10.032

Cited by 48 publications

(47 citation statements)

References 16 publications

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“…Since tumor cells in renal pelvis and ureter could exfoliate easily, the damage to renal pelvis, ureter, and bladder may result in tumor planting during operation. There are several techniques of distal ureteric excision: 8,13 (1) cystoscopic detachment of ureter without ligation or stapling; 14 (2) cystoscopic detachment of ureter with ureteric stripping technique; 15 (3) extravesical laparoscopic stapling of ureter; (4) cystoscopic detachment of the ureter with endoscopic ligation or stapling; 16 and (5) open excision of bladder cuff. 17 The technique of distal ureteric excision is still debatable, and the data reporting is also inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

Wang

Men

et al. 2015

International Surgery

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Retroperitoneal laparoscopic nephroureterectomy (LNU) combined with transurethral electric resection of ipsilateral bladder cuff is widely accepted to treat the upper urinary tract urothelial carcinoma (UUT-UC). To reduce the local recurrence rate, we improved the procedure from electric resection to electric coagulation. From May 2008 to July 2012, of all the 156 retroperitoneal LNU patients, 76 cases (test group) were performed with LNU combined with electric coagulation, and 80 cases (control group) were with electric resection. For the clinical outcomes, the hospital stay in the test group was shorter (5.2 6 2.6 days versus 8.2 6 3.4 days; P , 0.05), and the 1-year tumor recurrence rate was much lower (1.6% versus 13.3%, P , 0.05). There was no difference in operation time and blood loss between groups. Retroperitoneal LNU combined with electric coagulation is technically feasible and safe with lower tumor recurrence rate and shorter hospital stay.

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Section: Discussionmentioning

confidence: 99%

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

Wang

Men

et al. 2015

International Surgery

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“…Additionally, there were no differences in RFS and cancer-specific survival between groups. Walton and colleages 23 have also published a retrospective study comparing ENDOSCOPIC to INTRAVESICAL in 138 patients. These authors report equivalent RFS and disease-specific survival for these techniques.…”

Section: Discussionmentioning

confidence: 99%

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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“…(1) Cystoscopic detachment of the intramural ureter by transurethral resection prior to nephroureterectomy ('pluck' technique) [49] .…”

Section: Methodsmentioning

confidence: 99%

“…(2) Cystoscopic detachment of the ureter by transurethral complete circumferential incision of the intramural ureter with a bladder cuff without resection, ligation or stapling [49] .…”

Section: Methodsmentioning

confidence: 99%

Management of the Distal Ureter during Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Review

2010

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Introduction: The standard treatment for upper urinary tract transitional cell carcinoma (UUT-TCC) is open radical nephroureterectomy with excision of a bladder cuff. We assess the successful endoscopic completion and oncological efficacy of the various minimally invasive transurethral techniques devised for the management of the intramural ureter during nephroureterectomy. Materials and Methods: A comprehensive review of the English literature until February 2009 using the PubMed database returned 42 relevant papers. Five methods of endoscopic management of the distal ureter were identified and compared to the open technique. Results: There are no randomised studies. Successful completion of the endoscopic procedure was less (91%) for the ureteric stripping technique than for the other endoscopic modalities (99.8–100%). Recurrences were highest for laparoscopic extravesical ureteric stapling in conjunction with cystoscopic detachment of the ureter, although the numbers analysed were small. For the other endoscopic modalities, bladder recurrence, positive margins and retroperitoneal recurrence (20–37, 0–4 and 1–3%, respectively) in case series were similar compared with the open method (36, 5 and 3%, respectively). Conclusions: Current non-randomised evidence is open to selection bias and is insufficient to support or refute endoscopic management of the distal ureter as an alternative to open bladder cuff excision. We highlight the reported inefficiency of the ureteric stripping technique.

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Comparative Outcomes Following Endoscopic Ureteral Detachment and Formal Bladder Cuff Excision in Open Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma

Abstract: Endoscopic ureteral detachment reduces operative duration and is associated with equivalent oncological outcomes compared with open bladder cuff excision in nephroureterectomy. Caution should be exercised in patients with low ureteral tumors.

Cited by 48 publications

References 16 publications

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

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

Management of the Distal Ureter during Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Review

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