title: Nephrectomy plus endoscopy-assisted intussusception ureterectomy for patients with renal pelvic cancer: long-term oncologic outcomes in comparison with nephroureterectomy plus bladder cuff removal.
abstract: OBJECTIVE
  To assess long-term oncologic outcomes in patients with renal pelvic cancer who are receiving nephrectomy plus endoscopy-assisted intussusception ureterectomy. There has been no large study reporting long-term oncologic outcomes of this approach in comparison with those of conventional nephroureterectomy plus bladder cuff removal.
  
  
  METHODS
  We reviewed 181 consecutive patients with renal pelvic cancer who underwent open nephroureterectomy with complete bladder cuff removal (cuff removal group, n = 33), nephroureterectomy with incomplete cuff removal (orifice-remaining group, n = 39), and nephrectomy with intussusception ureterectomy (intussusception group, n = 109).
  
  
  RESULTS
  Patients in the intussusception group had larger tumor size, higher histologic grade, and more advanced pathologic stage (P = 0.005, 0.021, and 0.030, respectively), while the incidence of coexistent bladder/ureteral cancer was lower in this group (P < 0.001). The mean operative time was shorter in the intussusception group than in the cuff removal and orifice-remaining groups (201.2 ± 33.1 and 221.5 ± 47.2 min, respectively, P < 0.001). The 5-year extraurinary tract recurrence-free survival rate in the intussusception and cuff removal groups was 74.8% and 71.4%, respectively (log-rank P = 0.766), and it was lower in the orifice-remaining group compared with that in the intussusception group (P = 0.031). The 5-year urinary tract recurrence-free survival rate in the intussusception, cuff removal, and orifice-remaining groups was 76.6%, 65.0%, and 65.0%, respectively (intussusception vs cuff removal: P = 0.089). With both univariate and multivariate analyses, intussusception ureterectomy had no significant impact on urinary tract recurrence (multivariate P = 0.553, hazard ratio = 0.784).
  
  
  CONCLUSIONS
  Nephrectomy plus endoscopy-assisted intussusception ureterectomy is an oncologically safe alternative for renal pelvic cancer patients, which is possibly associated with less patient morbidity.
authors: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan. harasho@med.niigata-u.ac.jp
authors: Noboru
authors: N
authors: Hara
authors: Yasuo
authors: Y
authors: Kitamura
authors: Toshihiro
authors: T
authors: Saito
authors: Shunji
authors: S
authors: Wakatsuki
authors: Yasunosuke
authors: Y
authors: Sakata
authors: Shuichi
authors: S
authors: Komatsubara
mesh_terms: D000368:Aged; D003710:Demography; D018572:Disease-Free Survival; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000601:surgery*; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*