Nephrectomy plus endoscopy-assisted intussusception ureterectomy for patients with renal pelvic cancer: long-term oncologic outcomes in comparison with nephroureterectomy plus bladder cuff removal.

Abstract

PURPOSE:

To assess long-term oncologic outcomes in patients with renal pelvic cancer who are receiving nephrectomy plus endoscopy-assisted intussusception ureterectomy. There has been no large study reporting long-term oncologic outcomes of this approach in comparison with those of conventional nephroureterectomy plus bladder cuff removal.

PATIENTS AND METHODS:

We reviewed 181 consecutive patients with renal pelvic cancer who underwent open nephroureterectomy with complete bladder cuff removal (cuff removal group, n = 33), nephroureterectomy with incomplete cuff removal (orifice-remaining group, n = 39), and nephrectomy with intussusception ureterectomy (intussusception group, n = 109).

RESULTS:

Patients in the intussusception group had larger tumor size, higher histologic grade, and more advanced pathologic stage (P = 0.005, 0.021, and 0.030, respectively), while the incidence of coexistent bladder/ureteral cancer was lower in this group (P < 0.001). The mean operative time was shorter in the intussusception group than in the cuff removal and orifice-remaining groups (201.2 ± 33.1 and 221.5 ± 47.2 min, respectively, P < 0.001). The 5-year extraurinary tract recurrence-free survival rate in the intussusception and cuff removal groups was 74.8% and 71.4%, respectively (log-rank P = 0.766), and it was lower in the orifice-remaining group compared with that in the intussusception group (P = 0.031). The 5-year urinary tract recurrence-free survival rate in the intussusception, cuff removal, and orifice-remaining groups was 76.6%, 65.0%, and 65.0%, respectively (intussusception vs cuff removal: P = 0.089). With both univariate and multivariate analyses, intussusception ureterectomy had no significant impact on urinary tract recurrence (multivariate P = 0.553, hazard ratio = 0.784).

CONCLUSIONS:

Nephrectomy plus endoscopy-assisted intussusception ureterectomy is an oncologically safe alternative for renal pelvic cancer patients, which is possibly associated with less patient morbidity.

• Authors: Noboru Hara, Yasuo Kitamura, Toshihiro Saito, Shunji Wakatsuki, Yasunosuke Sakata, Shuichi Komatsubara
• Journal: Journal of endourology (J Endourol) Vol. 25 Issue 4 Pg. 691-7 (Apr 2011) ISSN: 1557-900X [Electronic] United States
• PMID: 21434766 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Topics

• Aged
• Demography
• Disease-Free Survival
• Endoscopy (adverse effects)
• Female
• Humans
• Intussusception (complications, surgery)
• Kidney Neoplasms (complications, surgery)
• Kidney Pelvis (pathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Nephrectomy (adverse effects, methods)
• Perioperative Care
• Postoperative Complications (etiology)
• Recurrence
• Treatment Outcome
• Ureter (surgery)
• Urinary Bladder (surgery)