title: Intraoperative prognostic factors and atypical patterns of recurrence in patients with upper urinary tract urothelial carcinoma treated with laparoscopic radical nephroureterectomy.
abstract: Objective The aims of this study were to identify clinical, intraoperative and pathological prognostic factors for predicting extraurothelial recurrence and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone laparoscopic radical nephroureterectomy (LRNU), and to investigate the site-specific patterns of recurrence and the associated outcomes. Materials and methods A retrospective revision was undertaken of 117 consecutive patients who had undergone transperitoneal LRNU for UTUC between 2007 and 2012. Univariate and multivariate Cox regression analyses were used to identify prognostic factors and Kaplan-Meier was used to estimate CSS. Results With a median follow-up of 20 months, 36 patients (30%) developed extraurothelial recurrence (local and/or distant). In the multivariate analysis, entering the urinary tract during LRNU was related to local recurrence (p = 0.04), management of the distal ureter to CSS (p = 0.003), pathological stage and positive margins to local (p = 0.001, p = 0.013), distant (p = 0.028, p = 0.009) and global recurrence (p = 0.05, p = 0.012) and CSS (p = 0.011, p = 0.042), and multifocality to distant recurrence (p = 0.024). Median time to recurrence was 11.4 months after LRNU. Of 36 patients with progression, 23 (64%) had simultaneous local and distant recurrence and eight had atypical metastases: two port-site metastases, five peritoneal, two subcutaneous and two abdominal wall implants. The 5 year CSS was 61% for all patients with UTUC and 9% for those with recurrence. Conclusions Intraoperative events could have a negative impact on the oncological outcomes of patients with UTUC treated with LRNU. The use of laparoscopy for advanced UTUC may be related to atypical ways of spreading.
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Carrion
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Huguet
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: García-Cruz
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Izquierdo
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Mateu
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Musquera
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Ribal
authors.affiliation: a Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000453:epidemiology* / Q000601:surgery*
keywords: Laparoscopic radical nephroureterectomy; port-site metastases; prognostic factors; recurrence; upper urinary tract urothelial carcinoma