803 Outcomes of Radical Nephroureterectomy: An Australian Multicentre Experience Using a Dedicated Upper Tract Data Registry

Abstract

Abstract Introduction Radical nephroureterectomy (RNU) is used for the treatment of upper tract urothelial carcinoma (UTUC). It is a procedure with considerable morbidity. Australian data on UTUC is limited, and we have recently developed the ACCEPT-U database to try and address this. This study aims to examine the surgical and oncological outcomes in patients who have undergone RNU. Method We collected data using the ACCEPT-U database on patients who underwent (RNU) across two tertiary centres in Victoria and Western Australia between 2013 and 2022. Our primary outcomes were overall survival at one, two, and five years. Our secondary outcomes included postoperative complications and recurrence data. Results One hundred and one patients underwent RNU during the study period. The median age was 73 (IQR 64.0 to 80.5) years. The median hospital length of stay was 7 days (IQR 5-11) overall. Neither operative technique, CCI nor age affected hospital length of stay (p >0.05). The 30-day post-operative complication rate was 35% (n=35), with a median Clavien Dindo of II. Overall survival rates at one, two, and five years were 89%. (95% CI 81.4 - 94.0%); 79% (95% CI 70.2 - 86.1%) and 73% (95% CI 63.9 – 81.0%). Advanced pathological stage was associated with reduced overall 5-year survival (Pearson Chi-Squared = 10.40, p=0.006). Conclusions Radical nephroureterectomy in patients with UTUC has considerable morbidity and mortality in Australian centres but this appears comparable to published rates. The ACCEPT-U database will facilitate larger and prospective data collection, hopefully across multiple institutions, to further assess peri-operative outcomes and their determinants in the future.