Presented by: Francesco Ditonno MD
Department of Urology, Rush University, Chicago IL, USA

Introduction

The role of kidney-sparing surgery (KSS) in patients with high-risk upper urinary tract urothelial carcinoma (UTUC) is controversial. The aim of this study was to assess the outcomes of robotic distal ureterectomy in patients with high-risk distal ureteral tumours. 

Materials

Three hundred and sixty-five patients with high-risk UTUC of the distal ureter were retrieved from the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) multicenter international (2006-2019). The study population was divided in two subgroups according to the type of surgical approach: 38 patients treated with robotic distal ureterectomy and 135 treated with robotic nephroureterectomy (RNU). Time to recurrence, defined by urinary cytology, CT scan or cystoscopy at last follow-up, was the primary endpoint. Secondary endpoint was the post-operative renal function, calculated as eGFR at last follow-up. A Mann-Whitney U test was performed to compare mean (± SD) of each outcome between the two populations.

Results

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In the overall population, mean age was 70.4 years (±9.3), with a mean preoperative Cr of 1.2 (±0.8) mg/dL and a mean tumour size of 3.3 (±2.1) cm. No significant difference was observed in terms of time to recurrence (13.3 months vs 14.3 months, p=0.8) between patients treated with distal ureterectomy and RNU. Post-operative eGFR, instead, was significantly better in patients treated with distal ureterectomy (63.4 mL/min/1.73m² vs 51 mL/min/1.73m², p=0.01). 

Conclusion

Within the limitations related to the retrospective study design, our findings suggest comparable outcomes in terms of time to recurrence between distal ureterectomy and RNU, and an advantage of in terms of post-operative renal function preservation. KSS might be considered as a potential option for selected high-risk patients. 

Funding

None

Lead Authors

Savio D. Pandolfo,
Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy.

Antonio Franco,
Department of Urology, Rush University, Chicago, IL 60612, USA

Ithaar H. Derweesh,
Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA

Vitaly Margulis,
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

Firas Abdollah,
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

Matteo Ferro,
Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy

Hooman Djaladat,
Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California, USA

Georgi Guruli,
Division of Urology, VCU Health, Richmond, VA, USA

Giuseppe Simone,
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy

Reza Mehrazin,
Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA

Co-Authors

Mark L. Gonzalgo,
Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA

Zhenjie Wu,
Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China

Francesco Porpiglia,
Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy

Daniel D. Eun,
Department of Urology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

Andreas Correas,
Fox Chase Cancer Center, Philadelphia, PA, USA

Andrea Minervini,
Department of Urology, University of Florence, Florence, Italy

Chandru P. Sundaram,
Department of Urology, Indiana University, Indianapolis, IN, USA

Riccardo Autorino,
Dept of Urology, Rush University, Chicago, IL, USA