To assess the oncological outcomes of several distal ureter management techniques in patients administered with radical nephroureterectomy (RNU) for primary upper urinary tract urothelial carcinoma (UTUC).
A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing outcomes following RNU under various surgical methods for bladder cuff management. Standard cumulative analyses of hazard ratios (HRs) with 95% confidence intervals (CIs) were performed using Review Manager (5.3).
Nine studies involving 4,683 patients were selected based upon eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences among intravesical incision of the bladder cuff (IVBC), extravesical incision of the bladder cuff (EVBC) and transurethral incision of the bladder cuff (TUBC) techniques. However, the IVBC technique appeared to have better recurrence-free survival (RFS) (HR= 1.37, p<0.01) and intravesical recurrence-free survival (IRFS) (HR=1.45, p<0.01) compared with non-IVBC methods, including both TUBC and EVBC. When studies involving patients with bladder tumour history were excluded, the pooled statistic appeared to confirm that IVBC was associated with improved IRFS (HR=1.25, p=0.03) compared with EVBC and TUBC. No significant difference was found between the EVBC and TUBC groups (HR=1.81, p=0.32).
The findings suggest that IVBC is associated with improved oncologic outcomes and that it may be recommended for distal ureter management. However, caution must be taken because this recommendation is based upon a very limited number of clinical studies. Further research with enhanced outcome data collection and improved reporting is required to confirm these findings.
International journal of surgery (London, England). 2020 Jan 21 [Epub ahead of print]
Shicong Lai, Runqi Guo, Samuel Seery, Pengjie Wu, Jianyong Liu, Yaoguang Zhang, Shengcai Zhu, Xiaoguang Li, Ming Liu, Jianye Wang
Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China., Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing 100730, China., School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China., Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China., Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: ., Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: .