To compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing kidney-sparing surgery (KSS) with fiber-optic (FO) vs digital (D) ureteroscopy (URS). To evaluate the oncological impact of image enhance technologies such as narrow-band imaging (NBI) and Image 1S in patients with UTUC.
The CROES-UTUC registry is an international, multicenter, cohort study prospectively collecting data on patients with UTUC. Patients undergoing flexible FO or D-URS for diagnostic or diagnostic and treatment purposes have been included. Differences between groups in terms of overall survival (OS) and disease-free survival (DFS) have been evaluated.
The CROES registry included 2380 patients from 101 centers and 37 countries, of whom 401 patients underwent URS (FO-URS:186 and D-URS:215). FO-URS were performed more frequently for diagnostic purposes while D-URS when a combined diagnostic and treatment strategy was planned. Intraoperative and postoperative complications did not differ between groups. 5-years OS and DFS rates were 91.5% and 66.4% respectively. Mean OS was 42 months for patients receiving FO-URS and 39 months for those undergoing D-URS (p=0.9); mean DFS was 28 months in the FO group and 21 months in the D group (p<0.001). In patients who received URS with treatment purposes, no difference regarding OS (p=0.9) and DFS (p=0.7) were observed. NBI and Image 1S technologies did not improve OS nor DFS over D-URS.
D-URS did not provide any oncological advantage over FO-URS. Similarly, no differences in terms of OS and DFS were found when image enhance technologies were compared to D-URS. These findings underline the importance of surgeon skills and experience and reinforce the need for the centralization of UTUC care.
BJU international. 2021 May 24 [Epub ahead of print]
Francesco Soria, M Pilar Laguna, Morgan Roupret, Patricio Garcia-Marchinena, Mariano Sebastián Gonzalez, Tomonori Habuchi, Erkan Erkan, Anthony Ng, Paolo Gontero, Jean de la Rosette
Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Medipol Mega University hospital, Istanbul Medipol University, Istanbul, Turkey., Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013, Paris, France., Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Akita University Graduate School of Medicine, Akita, Japan., TCSB Istanbul Training Hospital, Istanbul, Turkey., SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong.