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The Remaining Ipsilateral Ureteral Orifice Provokes Intravesical Tumor Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Study With a Mid-Term Follow-Up

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Author(s)
Se Yun KwonYoung Hwii KoPhil Hyun SongByung Hoon KimBum Soo KimTae-Hwan Kim
Keimyung Author(s)
Kim, Byung Hoon
Department
Dept. of Urology (비뇨의학)
Journal Title
Urology
Issued Date
2020
Volume
145
Abstract
Objectives:
To investigate the impact of the remnant ureteral orifice (RUO) on the prognosis of upper tract urothelial carcinoma (UTUC), because the presence of an ipsilateral intact ureteral orifice is not an uncommon finding during follow-up cystoscopy despite the clinical relevance of bladder cuffing during radical nephroureterectomy (RNU) for the management of UTUC.

Methods:
The records of patients who underwent RNU in all tertiary hospitals in Daegu province (2011-2018) were retrospectively reviewed. Subjects were allocated to RUO or non-RUO groups. Cox proportional hazard models were used to identify variables. The primary endpoint was a 5-year intravesical recurrence-free survival (RFS).

Results:
Of the 164 patients enrolled, 45 (27.4%) had an RUO by postoperative cystoscopy. The characteristics of the RUO and non-RUO groups were similar. During mean follow-up of 76.4 months (range: 69.5-83.4), 21 (46.7%) subjects in the RUO group and 25 (21.0%) in the non-RUO group experienced intravesical recurrence (P = .001). Among them, 3 (6.7%) and 14 (8.5%) developed distant metastasis (P = .339), and 3 (6.7%) and 9 (7.6%) succumbed to UTUC (P = .844), respectively. The 5-year RFS was lower in the RUO group than in the non-RUO counterpart (45.6% vs 77.8%, P = .003). Multivariate analysis showed lymphovascular invasion (hazard ratio [HR] = 3.593, P = .002), lymph nodal involvement (HR = 2.336, P = .038), and the presence of RUO (HR = 2.058, P = .026) predicted 5-year RFS.

Conclusion:
The presence of RUO after RNU was found to be significantly associated with intravesical tumor recurrence, and this finding emphasizes the quality of bladder cuffing during RNU, which could be assessed by complete removal of the natural orifice.
Keimyung Author(s)(Kor)
김병훈
Publisher
School of Medicine (의과대학)
Citation
Se Yun Kwon et al. (2020). The Remaining Ipsilateral Ureteral Orifice Provokes Intravesical Tumor Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Study With a Mid-Term Follow-Up. Urology, 145, 166–171. doi: 10.1016/j.urology.2020.06.083
Type
Article
ISSN
1527-9995
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0090429520309742
DOI
10.1016/j.urology.2020.06.083
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43326
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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