Using the United States Renal Data System, a prospective database that includes every hemodialysis patient in the United States, the authors identified 317 patients who underwent complete urinary tract extirpation during the study period. Post-operative details and complications were assessed. Competing risks analysis was used to estimate cancer-specific survival and Cox regression analysis was used to identify predictors of overall survival. Among the 317 patients included in the analysis, 70.9% were male and the mean age was 65.3 ± 12.9 years. Mean length of stay was 16.2 ± 15.3 days. Overall, 46.0% of patients experienced a complication within 30 days, of which infectious-related complications were most common (13.6%). On multivariable analysis, only female sex was predictive of experiencing a complication (OR 2.37, p<0.01). The 30-day mortality rate was 8.5%. Overall mortality at 1, 3, and 5 years was 45.3%, 69.0%, and 82.7%, respectively. Cancer-specific mortality at 1, 3, and 5 years was 10.0%, 15.7%, and 16.8%, respectively. Predictors of overall mortality were age (HR 1.03, 95%CI 1.02-1.04) and active smoking status (HR 3.35, 95%CI 1.50-7.50).
In summary, complete urinary tract extirpation is associated with significant morbidity and mortality, with less than 20% of patients surviving 5 years. Complication rate is similar to radical cystectomy, with nearly half of patients experiencing one within 30 days. This study represents the largest study evaluating outcomes following complete urinary tract extirpation.
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Co-Authors: Zachary Smith MD, Peter Langenstroer MD, Kenneth Jacobsohn MD, Scott Johnson MD
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC