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. 2022 Jul;16(7):E363-E369.
doi: 10.5489/cuaj.7612.

Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series

Gianpaolo P Carpinito  1 , Grayden S Cook  2 , Aaron N Tverye  2 , Samuel A Gold  1 , Yair Lotan  1 , Vitaly Margulis  1 , Jeffrey M Howard  1
Affiliations

Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series

Gianpaolo P Carpinito et al. Can Urol Assoc J. 2022 Jul.

Abstract

Introduction: Radical cystectomy (RC) and radical nephroureterectomy (RNU) are commonly performed in urological oncology. Concurrent disease in the upper tract and bladder is rare, so performing both procedures in the same setting is uncommon. Here, we report the perioperative and oncological outcomes of a single-institution series of concurrent RC+RNU.

Methods: We retrospectively reviewed the charts of patients who underwent concurrent RC+RNU for bladder and/or upper tract urothelial carcinoma between 2006 and 2020. Patient demographic and clinical factors, perioperative parameters, and oncological outcomes were obtained.

Results: Twenty-seven patients underwent RC+RNU during the study period; 22 (81%) were male. Median (interquartile range) patient age was 71 (67-75) years. All had a diagnosis of bladder cancer. Concurrent upper tract urothelial carcinoma (UTUC) was the indication for RNU in 12 cases (44%) and non-functional renal unit in the remainder. Two patients (7%) experienced early postoperative mortality. Eight patients (30%) experienced major complications (Clavien-Dindo >3). Complications did not vary significantly between those rendered anephric (5/16, 31%) and those who were not (3/11, 27%) (p=0.82, Chi-squared test). Median (95% confidence interval) and five-year overall survival were 47 (41-52) months and 42%, respectively. Six of 22 male patients (27%) experienced a urethral recurrence and three of 14 patients (21%) with non-functional kidneys had occult UTUC discovered on final pathology.

Conclusions: Combined RC+RNU carries an elevated perioperative risk, primarily in highly comorbid patients. Striking rates of occult UTUC in non-functional kidneys and of urethral recurrence after cystectomy were noted. RC+RNU is an appropriate option in select patients.

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Conflict of interest statement

Competing interests: Dr. Lotan has received consulting fees from Abbvie, Ambu, AstraZeneca, Cleveland Diagnostics, C2I Genomics, Fergene, Ferring Research, Hitachi, Nanorobotics, Nucleix, Photocure, Seattle Genetics, Stimit, Verity Pharmaceuticals, and Virtuoso Surgical; holds investments in CAPs Medical, C2I Genomics, Nanorobot, and Vessi; and has participated in clinical trials supported by Abbott, BioCanCell, Cepheid, FKD, GenomeDx, Karl Storz, MDxHealth, and Pacific Edge. The remaining authors do not report any competing personal or financial interests related to this work.

Figures

Figure 1
Figure 1
Overall survival (OS) of the patient cohort. Kaplan-Meier curves showing OS of patients undergoing combined radical cystectomy (RC) and nephroureterectomy (RNU). Median (95% confidence interval) and five-year OS were 47 (41–52) months and 42%, respectively.
Figure 2
Figure 2
Progression-free survival of the patient cohort. Kaplan-Meier curves showing progression-free survival of patients undergoing combined radical cystectomy (RC) and nephroureterectomy (RNU). Median (95% confidence interval) and five-year progression-free survival were 30 (16–44) months and 41%, respectively.
See this image and copyright information in PMC

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