A total of 1,718 patients with UTUC who underwent RNU were included in the analysis, 6% of whom did not have bladder cuff excision and 4% of whom underwent resection using other techniques. The median follow up was 24 months. Patients who underwent standard bladder cuff excision had a slightly longer length of stay (4 days) compared to those who underwent other techniques for removal and those who did not have bladder cuff excision (3 days; p = 0.01). However, there was no difference in complication rates across the three treatment groups (p = 0.7).
There were no significant differences in clinical or survival outcomes (bladder recurrence-free survival, non-bladder recurrence-free survival, metastatic-free survival, overall survival, and cancer-specific survival) between patients who underwent standard bladder cuff excision versus other excision techniques (all p > 0.1). However, excision of any kind was associated with a decreased risk of bladder-specific recurrence (p = 0.01). Across the cohort, the rate of bladder recurrence was 23% at 12 months and 28% at 24 months.
The findings from this study emphasize the clinical benefit of bladder cuff excision regardless of technique. While this is in line with prior studies, it is different from other retrospective studies that found no evidence of a positive impact of bladder cuff excision on survival outcomes. This study is limited by the small number of patients who underwent non-standard bladder cuff excision or did not have bladder cuff excision.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
- Yong C, Slaven JE, Wu Z, et al. The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry. Urol Oncol. 2024;42(11):373.e1-373.e7. doi:10.1016/j.urolonc.2024.06.001.