AUA 2018: Survival after Segmental Resection of Distal Ureter and Termino-Terminal Ureteral Anastomosis vs Bladder Cuff Removal and Ureteral Reimplantation for Urothelial Carcinoma of the Ureter

San Francisco, CA ( Kidney-sparing surgery (KSS) is an alternative to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). However, segmental resection of iliac and lumbar ureter seems to be associated with greater failure than for distal pelvic ureter. The overall (OS) and cancer specific survival (CSS) of patients treated with segmental resection and termino-terminal anastomosis of iliac or lumbar ureter (TT) were compared to that of patients treated with segmental resection of the distal pelvic ureter with bladder cuff removal and ureteral reimplantation (RR). The secondary endpoint was evaluation and comparison of TT vs. RR impact on renal function. 

Patients treated with KSS for ureteral UTUC in 5 European tertiary referral centers from 2003 to 2013 were included in the analysis. Patients with history of other malignancies, metastatic disease or radical cystectomy were excluded. Patients were treated with TT or RR according to tumor location and followed-up every 3, 4 and 6 months in the 1st, 2nd and 3rd-5th year, and then annually. Un-adjusted OS and CSS curves were compared by using Kaplan-Meier method for all-cause mortality and cumulative incidence for cancer-specific mortality. Multivariable Cox regression adjusted for age, gender, smoking status, biopsy, tumor localization, hydronephrosis, pre-operative creatinine, previous or concurrent bladder cancer, multifocality, tumor stage/grade, lymphadenectomy, number of lymph nodes excised, necrosis, positive surgical margin, lymph vascular invasion, and tumor in situ was used. Multivariable linear regression model was used to compare RNU and KSS for postoperative creatinine (at 3 months). 

Overall, 85 patients were included: 62 treated with TT and 23 with RR. Pre-operative characteristics were comparable between the groups. The median follow-up was 89 months (24-116 months). Patients treated with TT showed similar 5yOS and 5yCSS as compared to those treated with RR (87 % vs. 69%, p=0.148 and 93% vs. 92%, p=0.953, respectively). Moreover, at the adjusted analysis, no statistically significant postoperative differences were observed in creatinine levels among patients who underwent TT and RR. Only preoperative creatinine level was a significant determinant for its postoperative variation. 

In summary, patients treated with TT and RR showed comparable 5yOS and 5yCSS. Moreover, the only determinant on postoperative creatinine variation was its preoperative level, irrespective of the surgical technique.

Presented by: Alberto Abrate, Palermo, Italy
Co-Authors: Francesco Sessa, Arcangelo Sebastianelli, Florence, Italy, Cristina Scalici Gesolfo, Palermo, Italy, Mirko Preto, Turin, Italy, Alberto Olivero, Genoa, Italy, Virginia Varca, Andrea Benelli, Garbagnate Milanese, Milan, Italy, Carlo Pavone, Vincenzo Serretta, Marco Vella, Palermo, Italy, Eugenio Brunocilla, Bologna, Italy, Sergio Serni, Florence, Italy, Carlo Trombetta, Trieste, Italy, Carlo Terrone, Genoa, Italy, Andrea Gregori, Garbagnate Milanese, Milan, Italy, Andrea Lissiani, Trieste, Italy, Paolo Gontero, Turin, Italy, Riccardo Schiavina, Bologna, Italy, Mauro Gacci, Florence, Italy, Alchiede Simonato, Palermo, Italy

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA