Robot-Assisted Segmental Ureterectomy and Ureteroureterostomy: Sound Alternative for Treatment of Upper Tract Urinary Cancer in High-Risk Patients

Videourology ◽  
2020 ◽  
Vol 34 (4) ◽  
Author(s):  
Matteo Massanova ◽  
Felice Crocetto ◽  
Guglielmo Zeccolini ◽  
Giorgio Mazzon ◽  
Fabio Esposito ◽  
...  
Keyword(s):  
High Risk ◽  
Robot Assisted ◽  
Upper Tract ◽  
High Risk Patients ◽  
Risk Patients ◽  
Segmental Ureterectomy

scholarly journals MP62-04 COMPARATIVE EFFECTIVENESS OF ROBOT ASSISTED VS. OPEN RADICAL PROSTATECTOMY IN INTERMEDIATE AND HIGH RISK PATIENTS

2015 ◽  
Vol 193 (4S) ◽  
Author(s):  
Giorgio Gandaglia ◽  
Nazareno Suardi ◽  
Nicola Fossati ◽  
Alessandro Larcher ◽  
Elena Farina ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Comparative Effectiveness ◽  
Robot Assisted ◽  
High Risk Patients ◽  
Open Radical Prostatectomy ◽  
Risk Patients

scholarly journals Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

2018 ◽  
Vol 12 (8) ◽  
Author(s):  
Jennifer A. Locke ◽  
Reza Hamidizadeh ◽  
Wassim Kassouf ◽  
Ricardo A. Rendon ◽  
David Bell ◽  
...  
Keyword(s):  
High Risk ◽  
Urothelial Carcinoma ◽  
Multivariable Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Histological Features ◽  
Upper Tract ◽  
High Risk Patients ◽  
Risk Patients ◽  
Recurrence Patterns ◽  
Surveillance Protocol

Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large, multi-institutional cohort of patients.Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994–2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns.Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease, and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and high-risk patients.Conclusions: Based on recurrence patterns in a large, multicentre patient cohort, we have proposed an evidence-based, risk-adapted post-RNU surveillance protocol.

Adjuvant chemotherapy for high-risk upper tract urothelial carcinoma: Results from the Upper Tract Urothelial Carcinoma Collaboration

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5075-5075
Author(s):  
N. Hellenthal ◽  
S. F. Shariat ◽  
V. Margulis ◽  
P. I. Karakiewicz ◽  
M. Roscigno ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Performance Status ◽  
Tumor Grade ◽  
Upper Tract Urothelial Carcinoma ◽  
Cancer Specific Survival ◽  
Upper Tract ◽  
High Risk Patients ◽  
Risk Patients

5075 Background: There is relatively little literature regarding the use of adjuvant chemotherapy following radical nephroureterectomy in the management of patients with upper tract urothelial carcinoma (UTUC). Our goal was to determine the incidence of receipt of adjuvant chemotherapy in high-risk patients and the ensuing effect on overall- and cancer-specific survival. Methods: Using an international collaborative database, we identified 1390 patients who underwent nephroureterectomy for non-metastatic UTUC between the years of 1992 and 2006. Of these, 542 (39%) patients were classified as high-risk (pT3N0, pT4N0, and/or lymph node positive). These patients were separated into two groups—those who did and did not receive adjuvant chemotherapy—and were stratified by gender, age group, performance status, tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analyses were used to determine overall- and cancer-specific survival amongst the cohorts. Results: Of the high-risk patients, 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p < 0.001). Median survival in the entire cohort was 24 months (range 0–231 months). There was no significant difference in overall- or cancer-specific survival between those who did and did not receive adjuvant chemotherapy; however age, performance status, tumor grade, and tumor stage were significant predictors of both overall and cancer-specific survival. Conclusions: Adjuvant chemotherapy is infrequently utilized in the treatment of patients with high-risk UTUC after nephroureterectomy. Despite this, it appears that adjuvant chemotherapy confers minimal impact on overall- or cancer-specific survival in this group. No significant financial relationships to disclose.

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