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 Study (ROBUUST) 2.0 registry identified 1,718 patients undergoing RNU for UTUC between 2015 and 2023 at 17 centers across United States, Europe, and Asia. Data was gathered on (1) whether bladder cuff excision was performed and (2) what technique was including formal excision or other techniques (pluck technique, stripping/intussusception technique) and outcomes. Multivariate 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. 4% (68/1,718) underwent resection using other techniques, and 6% (110/1,718) did not have a bladder cuff excised. Median follow for the cohort was 24 months (IQR 9-44). - 44). When comparing formal bladder cuff excision to other excision techniques, there were no ences in oncologic or survival outcomes including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis survival (MFS), overall survival (OS), or cancer-specific survival (CSS). However, excision of any kind conferred a decreased bladder-specific recurrence compared to no excision. There was no difference in RFS, MFS, OS, or CSS when comparing bladder excision, other techniques, and no excision. Conclusions: Bladder cuff excision improves recurrence-free survival, particularly when considering bladder recurrence. This benefit conferred regardless of technique, as long as the intramural ureter and ureteral orifice are excised. However, the benefit of bladder excision on metastasis-free, overall, and cancer-specific survival is unclear. (c) 2024 Elsevier Inc. All rights are reserved, including text and data mining, AI training, and similar technologies.
The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry
Antonelli, Alessandro;Ditonno, Francesco;Franco, Antonio;Tozzi, Marco;
2024-01-01
Abstract
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 Study (ROBUUST) 2.0 registry identified 1,718 patients undergoing RNU for UTUC between 2015 and 2023 at 17 centers across United States, Europe, and Asia. Data was gathered on (1) whether bladder cuff excision was performed and (2) what technique was including formal excision or other techniques (pluck technique, stripping/intussusception technique) and outcomes. Multivariate 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. 4% (68/1,718) underwent resection using other techniques, and 6% (110/1,718) did not have a bladder cuff excised. Median follow for the cohort was 24 months (IQR 9-44). - 44). When comparing formal bladder cuff excision to other excision techniques, there were no ences in oncologic or survival outcomes including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis survival (MFS), overall survival (OS), or cancer-specific survival (CSS). However, excision of any kind conferred a decreased bladder-specific recurrence compared to no excision. There was no difference in RFS, MFS, OS, or CSS when comparing bladder excision, other techniques, and no excision. Conclusions: Bladder cuff excision improves recurrence-free survival, particularly when considering bladder recurrence. This benefit conferred regardless of technique, as long as the intramural ureter and ureteral orifice are excised. However, the benefit of bladder excision on metastasis-free, overall, and cancer-specific survival is unclear. (c) 2024 Elsevier Inc. All rights are reserved, including text and data mining, AI training, and similar technologies.
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