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Differential effect of surgical technique on intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial cancer: a systematic review and Meta-analysis.
Tsuboi, Ichiro; Matsukawa, Akihiro; Kardoust Parizi, Mehdi; Klemm, Jakob; Schulz, Robert J; Cadenar, Anna; Mancon, Stefano; Chiujdea, Sever; Fazekas, Tamás; Miszczyk, Marcin; Laukhtina, Ekaterina; Kawada, Tatsushi; Katayama, Satoshi; Iwata, Takehiro; Bekku, Kensuke; Wada, Koichiro; Gontero, Paolo; Rouprêt, Morgan; Teoh, Jeremy; Singla, Nirmish; Araki, Motoo; Shariat, Shahrokh F.
Afiliación
  • Tsuboi I; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Matsukawa A; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.
  • Kardoust Parizi M; Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
  • Klemm J; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Schulz RJ; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
  • Cadenar A; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Mancon S; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Chiujdea S; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Fazekas T; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Miszczyk M; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Laukhtina E; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Kawada T; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Katayama S; Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.
  • Iwata T; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Bekku K; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
  • Wada K; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Gontero P; Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Science, and Technology of Targu Mures, Pharmacy, Mures, Romania.
  • Rouprêt M; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Teoh J; Department of Urology, Semmelweis University, Budapest, Hungary.
  • Singla N; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
  • Araki M; Collegium Medicum - Faculty of Medicine, WSB University, Dabrowa Górnicza, Poland.
  • Shariat SF; Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
World J Urol ; 42(1): 488, 2024 Aug 20.
Article en En | MEDLINE | ID: mdl-39162743
ABSTRACT
CONTEXT Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment in patients with high-risk upper tract urothelial cancer (UTUC). However, it is unclear which specific surgical technique may lead to improve oncological outcomes in term of intravesical recurrence (IVR) in patients with UTUC.

OBJECTIVE:

To evaluate the efficacy of surgical techniques and approaches of RNU in reducing IVR in UTUC patients. EVIDENCE ACQUISITION Three databases were queried in January 2024 for studies analyzing UTUC patients who underwent RNU. The primary outcome of interest was the rate of IVR among various types of surgical techniques and approaches of RNU. EVIDENCE

SYNTHESIS:

Thirty-one studies, comprising 1 randomized controlled trial and 1 prospective study, were included for a systematic review and meta-analysis. The rate of IVR was significantly lower in RNU patients who had an early ligation (EL) of the ureter compared to those who did not (HR 0.64, 95% CI 0.44-0.94, p = 0.02). Laparoscopic RNU significantly increased the IVR compared to open RNU (HR 1.28, 95% CI 1.06-1.54, p < 0.001). Intravesical bladder cuff removal significantly reduced the IVR compared to both extravesical and transurethral bladder cuff removal (HR 0.65, 95% CI 0.51-0.83, p = 0.02 and HR 1.64, 95% CI 1.15-2.34, p = 0.006, respectively).

CONCLUSIONS:

EL of the affected upper tract system, ureteral management, open RNU, and intravesical bladder cuff removal seem to yield the lowest IVR rate in patients with UTUC. Well-designed prospective studies are needed to conclusively elucidate the optimal surgical technique in the setting of single post-operative intravesical chemotherapy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Ureterales / Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales / Nefroureterectomía / Neoplasias Renales / Recurrencia Local de Neoplasia Límite: Humans Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Ureterales / Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales / Nefroureterectomía / Neoplasias Renales / Recurrencia Local de Neoplasia Límite: Humans Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania