We sought to determine whether bladder cuff excision and its technique influence outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
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.
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.
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.
Urologic oncology. 2024 Aug 06 [Epub ahead of print]
Courtney Yong, James E Slaven, Zhenjie Wu, Vitaly Margulis, Hooman Djaladat, Alessandro Antonelli, Giuseppe Simone, Raj Bhanvadia, Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Francesco Ditonno, Gabriele Tuderti, Stephan Bronimann, Sohail Dhanji, Benjamin Eilender, Antonio Franco, Marco Finati, Marco Tozzi, Emma Helstrom, Dinno F Mendiola, Daniele Amparore, Francesco Porpiglia, Sol C Moon, Soroush Rais-Bahrami, Ithaar Derweesh, Reza Mehrazin, Riccardo Autorino, Firas Abdollah, Matteo Ferro, Andres Correa, Nirmish Singla, Mark L Gonzalgo, Chandru P Sundaram
Indiana University Department of Urology, Indianapolis, IN., Indiana University Department of Biostatistics and Health Data Science, Indianapolis, IN., Changhai Hospital Naval Medical University Department of Urology, Shanghai, China., University of Texas Southwestern Medical Center Department of Urology, Dallas, TX., University of Southern California Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA., University of Verona Department of Urology, Verona, Italy., IRCCS Regina Elena National Cancer Institute Department of Urology, Rome, Italy., Department of Urology, The Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., University of California San Diego School of Medicine Department of Urology, La Jolla CA., Icahn School of Medicine at Mount Sinai Hospital Department of Urology, New York, NY., Rush University Department of Urology, Chicago, IL., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI., European Institute of Oncology (IEO)-IRCCS Division of Urology, Milan, Italy., Fox Chase Cancer Center, Philadelphia, PA., Department of Urology, Desai Sethi Urology Institute University of Miami Miller School of Medicine, Miami, FL., Division of Urology, University of Turin San Luigi Gonzaga Hospital, Turin, Italy., Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL., Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL., Departments of Urology and Oncology, The Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Indiana University Department of Urology, Indianapolis, IN. Electronic address: .