Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma.

BACKGROUND: There is a lack of consensus regarding the prognostic significance of different approaches to the bladder cuff at surgery for primary upper urinary tract urothelial carcinoma (UUT-UC).

OBJECTIVES: To compare the oncologic outcomes following radical nephroureterectomy using three different methods of managing the bladder cuff.

DESIGN, SETTING, AND PARTICIPANTS: From January 1990 to December 2007, 414 patients with primary UUT-UC underwent radical nephroureterectomy at our institution. Of these, 301 were included in our study.

INTERVENTION: Three methods of bladder cuff excision-intravesical incision, extravesical incision, and transurethral incision (TUI)-were performed.

MEASUREMENTS: Patients' medical records were reviewed retrospectively. The clinicopathologic data and oncologic outcomes were compared among groups.

RESULTS AND LIMITATIONS: Of the 301 patients, 81 (26.9%) underwent the intravesical method, 129 (42.9%) underwent the extravesical technique, and 91 (30.2%) underwent TUI. There were no differences in clinical and histopathologic data among the three groups. When comparing the intravesical, extravesical, and TUI techniques, bladder recurrence developed in, respectively, 23.5%, 24.0%, and 17.6% cases (p=0.485); local retroperitoneal recurrence in 7.4%, 7.8%, and 5.5% (p=0.798); contralateral recurrence in 4.9%, 3.9%, and 2.2% (p=0.632); and distant metastasis in 7.4%, 10.4%, and 5.5% (p=0.564). There were no differences in recurrence-free and cancer-specific survival among the three groups (p=0.680 and 0.502, respectively).

CONCLUSIONS: The three techniques had comparable oncologic outcomes. Our data validate the TUI method of bladder cuff control in patients with primary UUT-UC without coexistent bladder tumors.