SUO 2017: A Nationwide Analysis of Complete Urinary Tract Extirpation

Washington, DC ( Dr. Jipp and colleagues assessed a nationwide analysis of complete urinary tract extirpation. Indications for complete urinary tract extirpation (bilateral nephroureterectomy and radical cystectomy) include concomitant upper and lower tract urothelial carcinoma or patients with chronic renal failure and urothelial carcinoma. Given the rarity of this operation, descriptions of complete urinary tract extirpation are limited to case reports and small case series. The objective of this study was to use a population-based database to assess long-term outcomes following complete urinary tract extirpation.

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.

Presented by: Jacob Jipp, Medical College of Wisconsin, Milwaukee, WI
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