The consequences of inadvertent radical nephrectomy in the treatment of upper tract urothelial carcinoma.

To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU).

Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n=820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n=16,464) between 2005-15. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching.

A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (p<0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62).

Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.

Urology. 2021 Mar 22 [Epub ahead of print]

Bashir Al Hussein Al Awamlh, Jonathan E Shoag, Spyridon P Basourakos, Patrick J Lewicki, Lina Posada, Xiaoyue Ma, Jay D Raman, Shahrokh F Shariat, Douglas Scherr

Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, USA. Electronic address: ., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, USA., Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA., Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA, USA., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, USA; Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Texas Southwestern, Dallas, Texas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan.