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Oncologic and Safety Outcomes for Retrograde and Antegrade Endoscopic Surgeries for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis
E. Laukhtina, T. Kawada, F. Quhal, T. Yanagisawa, P. Rajwa, M. von Deimling, M. Pallauf, A. Bianchi, M. Majdoub, D. Enikeev, H. Fajkovic, JY. Teoh, M. Rouprêt, P. Gontero, SF. Shariat
Jazyk angličtina Země Nizozemsko
Typ dokumentu metaanalýza, systematický přehled, časopisecké články, přehledy
- MeSH
- karcinom z přechodných buněk * chirurgie patologie MeSH
- lidé MeSH
- nádory ledvin * chirurgie patologie MeSH
- nádory močového měchýře * MeSH
- nádory močovodu * chirurgie patologie MeSH
- ureteroskopie škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
The aim of this study was to identify and summarize available data on oncologic and safety outcomes for retrograde versus antegrade endoscopic surgery in patients with upper tract urothelial carcinoma (UTUC). We systematically searched studies reporting on endoscopic surgery in patients with UTUC. The primary outcome of interest was oncologic control, including bladder and upper urinary tract recurrences. The secondary outcomes were any-grade and major complications. Twenty studies comprising 1091 patients were included in our analysis. The pooled bladder recurrence rate was 35% (95% confidence interval [CI] 28.0-42.3%; I2 = 48%) after retrograde endoscopic surgery and 17.7% (95% CI 6.5-32.1%; I2 = 29%) after antegrade endoscopic surgery. The pooled upper urinary tract recurrence rate was 56.4% (95% CI 41.2-70.9; I2 = 93%) after retrograde endoscopic surgery and 36.2% (95% CI 25.5-47.6%; I2 = 57%) after antegrade endoscopic surgery. The pooled complication rate was 12.5% (95% CI 0.8-32.8%; I2 = 94%) for any-grade complications and 6.6% (95% CI 0.1-19.1%; I2 = 89%) for major complications in the retrograde endoscopic cohort. In summary, our analyses suggest promising oncologic benefits of antegrade kidney-sparing surgery in terms of bladder and upper urinary tract recurrence rates in UTUC. Retrograde endoscopic surgery is a safe procedure with a minimal risk of complications and acceptable oncologic outcomes. Research should address the hypothesis that endoscopic antegrade surgery can be a safe and effective alternative for well-selected patients. PATIENT SUMMARY: One of the surgical options for treatment of cancer of the upper urinary tract is removal of the tumor through a small telescope called an endoscope. The endoscope can be inserted via the urethra (called a retrograde approach) or through a small incision in the skin (antegrade approach). Our review shows that the antegrade approach seems to provide acceptable cancer control rates. Further research could help to identify the role for endoscope surgery in cancer of the upper urinary tract.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czechia
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Hillel Yaffe Medical Center Hadera Israel
Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata Verona Italy
Department of Urology Weill Cornell Medical College New York NY USA
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
S H Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China
Citace poskytuje Crossref.org
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- $a Laukhtina, Ekaterina $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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- $a The aim of this study was to identify and summarize available data on oncologic and safety outcomes for retrograde versus antegrade endoscopic surgery in patients with upper tract urothelial carcinoma (UTUC). We systematically searched studies reporting on endoscopic surgery in patients with UTUC. The primary outcome of interest was oncologic control, including bladder and upper urinary tract recurrences. The secondary outcomes were any-grade and major complications. Twenty studies comprising 1091 patients were included in our analysis. The pooled bladder recurrence rate was 35% (95% confidence interval [CI] 28.0-42.3%; I2 = 48%) after retrograde endoscopic surgery and 17.7% (95% CI 6.5-32.1%; I2 = 29%) after antegrade endoscopic surgery. The pooled upper urinary tract recurrence rate was 56.4% (95% CI 41.2-70.9; I2 = 93%) after retrograde endoscopic surgery and 36.2% (95% CI 25.5-47.6%; I2 = 57%) after antegrade endoscopic surgery. The pooled complication rate was 12.5% (95% CI 0.8-32.8%; I2 = 94%) for any-grade complications and 6.6% (95% CI 0.1-19.1%; I2 = 89%) for major complications in the retrograde endoscopic cohort. In summary, our analyses suggest promising oncologic benefits of antegrade kidney-sparing surgery in terms of bladder and upper urinary tract recurrence rates in UTUC. Retrograde endoscopic surgery is a safe procedure with a minimal risk of complications and acceptable oncologic outcomes. Research should address the hypothesis that endoscopic antegrade surgery can be a safe and effective alternative for well-selected patients. PATIENT SUMMARY: One of the surgical options for treatment of cancer of the upper urinary tract is removal of the tumor through a small telescope called an endoscope. The endoscope can be inserted via the urethra (called a retrograde approach) or through a small incision in the skin (antegrade approach). Our review shows that the antegrade approach seems to provide acceptable cancer control rates. Further research could help to identify the role for endoscope surgery in cancer of the upper urinary tract.
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- $a Kawada, Tatsushi $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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- $a Quhal, Fahad $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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- $a Shariat, Shahrokh F $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. Electronic address: shahrokh.shariat@meduniwien.ac.at
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