The role of bladder-cuff excision (BCE) at radial nephroureterectomy (RNU) is undisputed. However, the rates of BCE adherence are not optimal. This may be related to the burden of cancer or to the robot-assistance adoption that may have facilitated the visualization as well as the resection of intramural ureter. There is a paucity of data on the oncological outcomes of upper tract urothelial carcinoma (UTUC) patients who did not receive BCE. A novel SEER based study addressed this topic.1
The study included 4,426 non-metastatic UTUC patients. Of those, 72% (n=3,186) received the BCE. Specifically, BCE rates significantly increased over time from 65.2 to 77.0% between 2004 and 2020.
Despite the SEER databases does not allow to account for intravesical recurrence rate (IVR) that may be related directly to cancer-specific mortality (CSM), the survival comparison between UTUC patients who received BCE and who did not receive BCE may be helpful to understand the need to implement as far as possible the adherence to BCE.
Key findings
- RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70−0.93).
- BCE status did not affect OCM (P = 0.4).
- The benefit of BCE at RNU was present before and after propensity score matching 1:1 for T stage.
Clinical Implications and Conclusions
BCE should be the main step of RNU. Avoiding BCE may hinder the survival of UTUC patients. Despite the limitations of a population-based study, this is the only way to describe a scenario that could not be represented in a prospective trial.
Written by: Francesco Di Bello, MD, Resident in Urology, University of Naples Federico II, Naples, Italy
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