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Differential effect of surgical technique on intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial cancer: a systematic review and Meta-analysis
I. Tsuboi, A. Matsukawa, M. Kardoust Parizi, J. Klemm, RJ. Schulz, A. Cadenar, S. Mancon, S. Chiujdea, T. Fazekas, M. Miszczyk, E. Laukhtina, T. Kawada, S. Katayama, T. Iwata, K. Bekku, K. Wada, P. Gontero, M. Rouprêt, J. Teoh, N. Singla, M....
Jazyk angličtina Země Německo
Typ dokumentu systematický přehled, časopisecké články, metaanalýza
- MeSH
- karcinom z přechodných buněk * chirurgie patologie MeSH
- lidé MeSH
- lokální recidiva nádoru * epidemiologie MeSH
- nádory ledvin * chirurgie patologie MeSH
- nádory močového měchýře * chirurgie patologie MeSH
- nádory močovodu * chirurgie MeSH
- nefroureterektomie * metody MeSH
- ureter chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
CONTEXT: Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment in patients with high-risk upper tract urothelial cancer (UTUC). However, it is unclear which specific surgical technique may lead to improve oncological outcomes in term of intravesical recurrence (IVR) in patients with UTUC. OBJECTIVE: To evaluate the efficacy of surgical techniques and approaches of RNU in reducing IVR in UTUC patients. EVIDENCE ACQUISITION: Three databases were queried in January 2024 for studies analyzing UTUC patients who underwent RNU. The primary outcome of interest was the rate of IVR among various types of surgical techniques and approaches of RNU. EVIDENCE SYNTHESIS: Thirty-one studies, comprising 1 randomized controlled trial and 1 prospective study, were included for a systematic review and meta-analysis. The rate of IVR was significantly lower in RNU patients who had an early ligation (EL) of the ureter compared to those who did not (HR: 0.64, 95% CI: 0.44-0.94, p = 0.02). Laparoscopic RNU significantly increased the IVR compared to open RNU (HR: 1.28, 95% CI: 1.06-1.54, p < 0.001). Intravesical bladder cuff removal significantly reduced the IVR compared to both extravesical and transurethral bladder cuff removal (HR: 0.65, 95% CI: 0.51-0.83, p = 0.02 and HR: 1.64, 95% CI: 1.15-2.34, p = 0.006, respectively). CONCLUSIONS: EL of the affected upper tract system, ureteral management, open RNU, and intravesical bladder cuff removal seem to yield the lowest IVR rate in patients with UTUC. Well-designed prospective studies are needed to conclusively elucidate the optimal surgical technique in the setting of single post-operative intravesical chemotherapy.
Collegium Medicum Faculty of Medicine WSB University Dąbrowa Górnicza Poland
Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy
Department of Surgery S H Ho Urology Centre The Chinese University of Hong Kong Hong Kong SAR China
Department of Urology 2nd Faculty of Medicine Charles University Prague Czechia Czechia
Department of Urology Jikei University School of Medicine Tokyo Japan
Department of Urology Semmelweis University Budapest Hungary
Department of Urology Shariati Hospital Tehran University of Medical Sciences Tehran Iran
Department of Urology Shimane University Faculty of Medicine Shimane Japan
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Division of Urology Department of Special Surgery The University of Jordan Amman Jordan
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Citace poskytuje Crossref.org
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- $a Tsuboi, Ichiro $u Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria $u Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan $u Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan $1 https://orcid.org/0000000231358262
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- $a Differential effect of surgical technique on intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial cancer: a systematic review and Meta-analysis / $c I. Tsuboi, A. Matsukawa, M. Kardoust Parizi, J. Klemm, RJ. Schulz, A. Cadenar, S. Mancon, S. Chiujdea, T. Fazekas, M. Miszczyk, E. Laukhtina, T. Kawada, S. Katayama, T. Iwata, K. Bekku, K. Wada, P. Gontero, M. Rouprêt, J. Teoh, N. Singla, M. Araki, SF. Shariat
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- $a CONTEXT: Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment in patients with high-risk upper tract urothelial cancer (UTUC). However, it is unclear which specific surgical technique may lead to improve oncological outcomes in term of intravesical recurrence (IVR) in patients with UTUC. OBJECTIVE: To evaluate the efficacy of surgical techniques and approaches of RNU in reducing IVR in UTUC patients. EVIDENCE ACQUISITION: Three databases were queried in January 2024 for studies analyzing UTUC patients who underwent RNU. The primary outcome of interest was the rate of IVR among various types of surgical techniques and approaches of RNU. EVIDENCE SYNTHESIS: Thirty-one studies, comprising 1 randomized controlled trial and 1 prospective study, were included for a systematic review and meta-analysis. The rate of IVR was significantly lower in RNU patients who had an early ligation (EL) of the ureter compared to those who did not (HR: 0.64, 95% CI: 0.44-0.94, p = 0.02). Laparoscopic RNU significantly increased the IVR compared to open RNU (HR: 1.28, 95% CI: 1.06-1.54, p < 0.001). Intravesical bladder cuff removal significantly reduced the IVR compared to both extravesical and transurethral bladder cuff removal (HR: 0.65, 95% CI: 0.51-0.83, p = 0.02 and HR: 1.64, 95% CI: 1.15-2.34, p = 0.006, respectively). CONCLUSIONS: EL of the affected upper tract system, ureteral management, open RNU, and intravesical bladder cuff removal seem to yield the lowest IVR rate in patients with UTUC. Well-designed prospective studies are needed to conclusively elucidate the optimal surgical technique in the setting of single post-operative intravesical chemotherapy.
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- $a Matsukawa, Akihiro $u Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, A-1090, Austria $u Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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