Transitional-cell carcinoma recurrence rate after nephroureterectomy in patients who undergo open excision of bladder cuff v transurethral incision of the ureteral orifice.
OBJECTIVE
The gold standard treatment for upper-tract transitional-cell carcinoma is radical nephroureterectomy, but management of the distal ureter is not standardized. Two treatment options to detach the distal ureter are open cystotomy (OC) and excision of a bladder cuff or transurethral incision of the ureteral orifice (TUIUO). We compared the clinico-pathologic outcomes of these two techniques.


METHODS
Hospital records were reviewed on all 51 patients who had undergone open or laparoscopic nephroureterectomy at our institution between 1 January 1990 and 30 June 2005. Patient demographics, intraoperative parameters, and pathology data were collected. The mean follow-up was 23.2 months (range 4.5-75 months) and 22.1 months (range 1-50 months) for the OC and TUIUO groups, respectively. There were no significant differences in sex, age at operation, American Society Anesthesiologists risk score, previous transitional-cell tumors, pathologic tumor grade and stage, or metastatic disease status in the two groups.


RESULTS
Five patients had an unplanned incomplete ureterectomy. The bladder recurrence rates were similar in the OC group (22.2%; 6/27) and the TUIUO group (26.3%; 5/19). There were no pelvic recurrences in either group. Four of the five patients who had an incomplete ureterectomy had tumor recurrences, three in the form of metastatic disease.


CONCLUSIONS
Management of the distal ureter by TUIUO in appropriate patients offers the same rate of bladder recurrence as OC. Incomplete ureterectomy results in a significantly higher rate of recurrence, often associated with the development of metastatic disease.
Ko
Raymond
R
Division of Urology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
Chew
Ben H
BH
Hickling
Duane R
DR
Razvi
Hassan
H
Luke
Patrick P
PP
Chin
Joseph L
JL
Izawa
Jonathan I
JI
Pautler
Stephen E
SE
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000517:prevention & control*; D001743:Urinary Bladder / Q000601:surgery*