Abstract
Objectives: In this study, we evaluate the clinicopathological independent prognostic factors which to predict IVR in patients who underwent Laparoscopic-assisted radical nephroureterectomy (LRNU) for upper urinary tract carcinoma (UTUC). Methods: Between April 2008 to February 2019, we analyzed 100 japanese patients who were underwent LRNU and 92 patients who were underwent open radical nephroureterectomy (ORNU) at our institutions by retrospectively. The Patients characteristics factors, the clinicopathologic factors were collected. The intravesical recurrence free survival (IVRFS) were analyzed using the Kaplan-Meier method and Univariate and multivariate method by using the Cox proportional hazards regression models were performed to identify independent risk factors for IVR after LRNU. Results: In LRNU group, IVR was observed in 39 cases (39%), and it was not significant difference compare with ORNU (P: 0.36). Tumor location (P=0.002), Tumor size (P=0.001), preoperative urine cytology (P<0.0001), the pneumoperitoneum time (P: 0.0005) and adjuvant chemotherapy (P=0.019) showed significant association with postoperative IVR. In the multivariate Cox hazard models, the tumor location (P=0.0003), positive preoperative urinary cytology (P=0.003), and absence of adjuvant chemotherapy (P=0.003) were independent risk factors for subsequent IVR. There were not associated with smoking, Brinkman index, hydronephrosis and ureterorenoscopy before RNU for IVR. Overal survival (OS) was not significant association for experience IVR (P=0.15). Conclusion: In this study, LRNU was not shown to have a significantly higher IVR compared to ORNU. Patients with ureteral cancer and positive preoperative urinary cytology had a higher risk of IVR after LRNU. The adjuvant chemotherapy was significantly decreased the risk for postoperative IVR.
Highlights
Radical nephroureterectomy (RNU) is widely performed as a standard procedure for treatment of the UTUC
We found that 34.3% of patients with UTUC experienced IVR within a median interval of 13.6 months between RNU and the first IVR
Previous multicenter analysis described that presence of the hydronephrosis had multifocal tumors and positive urinary cytology, and these factors may be responsible for the increased rate of IVR [6]
Summary
Radical nephroureterectomy (RNU) is widely performed as a standard procedure for treatment of the UTUC. Surgical invasiveness is reduced, and RNU can be performed relatively safely even in cases with many complications or elderly patients. One of them is the risk of postoperative IVR. Some studies have discussed clinicopathologic specific risk factors for prediction of IVR [1, 2]. In Meta-analysis, laparoscopic procedure has been reported to be a significant risk factor for IVR [3]. The IVR after RNU often occurs with an approximately 15%–50% incidence [4]. The certain mechanism of IVR after LRNU has been unclear.
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