Perioperative And Oncologic Outcomes After Concurrent Cystectomy And Nephroureterectomy

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-16 PERIOPERATIVE AND ONCOLOGIC OUTCOMES AFTER CONCURRENT CYSTECTOMY AND NEPHROURETERECTOMY Grayden Cook, Jeffrey Howard, Vitaly Margulis, Arthur Sagalowsky, Ganesh Raj, Solomon Woldu, Aditya Bagrodia, and Yair Lotan Grayden CookGrayden Cook More articles by this author , Jeffrey HowardJeffrey Howard More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Arthur SagalowskyArthur Sagalowsky More articles by this author , Ganesh RajGanesh Raj More articles by this author , Solomon WolduSolomon Woldu More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy (RNU) and cystectomy (RC) are commonly performed in urologic oncology, but their concurrent use is rare. Here, we report the perioperative and oncologic outcomes of a single-institution series of concurrent RNU and RC. METHODS: We retrospectively reviewed our institutional RNU database to identify patients who underwent concurrent RNU/RC for malignancy between 2006 and 2020. Patient demographic and clinical factors, perioperative parameters, and oncologic outcomes were obtained by chart review. RESULTS: Twenty-seven patients underwent concurrent RNU/RC during the study period, of whom 22 (82%) were male. Median (IQR) patient age was 71 (66-76) years. The indication for concurrent RNU was upper tract urothelial carcinoma (UTUC) in 15 cases (56%) and nonfunctional kidney in 12 cases (44%). Eleven patients (41%) were rendered anephric by the procedure.Thirteen (48%) cases were performed by an open approach, nine (33%) via a robotic approach, and the remaining five (19%) by a hybrid (laparoscopic kidney / open bladder) approach. Median (IQR) estimated blood loss was 600 (250-1150) mL and operative time was 381 (290-408) minutes. Median (IQR) postoperative length of stay was 6 (4-9) days. Two patients (7.4%) experienced early postoperative mortality, one due to a myocardial infarction and the other due to sepsis from a deep surgical site infection. Notably, these deaths were in the two patients with the highest preoperative Charlson-Deyo comorbidity scores (9 and 10). Eight patients (30%) experienced a Clavien-Dindo grade 3 or 4 complication.Fourteen (52%) were alive at last follow-up, with median follow up of 33 months. Median progression-free (PFS) and overall survival (OS) were 32 and 47 months, respectively. Notably, 5 out of 22 male patients (23%) experienced a urethral recurrence at a median of 19 months postoperatively. CONCLUSIONS: We present one of the largest published series of outcomes following concurrent RNU/RC. There is a high risk of perioperative death in comorbid patients. A substantial proportion of patients do achieve long-term survival following concurrent RNU/RC, making it an appropriate option in management of carefully selected patients. Close surveillance of the remnant urethra is important in male patients given high rates of urethral recurrence. Source of Funding: This study was funded internally by the UTSW Department of Urology © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e871-e871 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grayden Cook More articles by this author Jeffrey Howard More articles by this author Vitaly Margulis More articles by this author Arthur Sagalowsky More articles by this author Ganesh Raj More articles by this author Solomon Woldu More articles by this author Aditya Bagrodia More articles by this author Yair Lotan More articles by this author Expand All Advertisement Loading ...