Category: Clinical Oncology: Outcomes & Complications
Introduction & Objective :
5-year overall survival estimates for patients that undergo radical nephroureterectomy and bladder cuff excision for upper tract urothelial carcinoma (UTUC) range from five to 86.4%. Given the varied range, the primary objective is to define significant risk factors for predicting overall survival in a cohort of patients undergoing robot-assisted laparoscopic radical nephroureterectomy and bladder cuff excision.
From 2006 to 2017, 90 patients who underwent robotic RNUBCE for high-risk UTUC were reviewed. Preoperative and perioperative variables were studied to determine significant predictors of overall survival. Hazard ratios and 95% confidence intervals were constructed to determine predictors of overall survival.
A total of 90 patients with a mean age of 70.9 and BMI 27.4 underwent robotic RNUBCE for high-risk UTUC. Median follow-up was 31.5 months with a range of 6 to 114.2 months. 57.8% of patients had > T2 disease on final pathology with a mean tumor size of 4.5cm. Bladder cuff was successfully excised in 88.9% of patients. Factors that precluded BCE were densely, fibrotic reaction near the ureterovesical junction due to prior vascular or pelvic surgery in eight patients, patient co-morbidity with anesthetic risk in one patient, and a presumptive diagnosis of renal cell carcinoma (with postoperative diagnosis of UTUC) in one patient. 5-year overall and cancer-specific survival rate was 41.5 and 57.9 percent, respectively. Of the preoperative variables examined, age and preoperative creatinine (continuous variable) significantly impacted overall survival with hazard ratios and 95% confidence intervals of 1.47 (1.22-1.77, p> pT3), LVI, margin status, and not performing bladder cuff excision (Table 1).
Conclusions : In this robotic cohort of patients undergoing RNUBCE for UTUC, increasing age and elevated creatinine significantly impacted OS. Advanced disease, LVI, positive margins and not excising bladder cuff also negatively impacted survival.
Wake Forest Baptist Medical Center
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina
Dr. Hemal is working as a professor in the department of Urology, Comprehensive Cancer Center & Prof., Institute for Regenerative Medicine at Wake Forest Baptist Medical Center. He is well known for his pioneering work in minimally invasive surgery. He has been active in the field of endourology since 1989, laparoscopy since 1992 and robot-assisted surgery since 2001. His contributions to laparoscopic & robot-assisted urologic surgery include the development of new techniques in uro-oncology & commitment to sharing and disseminating knowledge. He has conducted live demonstrations of endourological, laparoscopic & robot-assisted urologic procedures at more than 350 conferences around the world. He has been a visiting professor to more than 350 institutions around the globe to deliver guest lectures and keynote speeches. His trainees have been involved in the establishment of more than 50 minimally invasive programs. He has edited six books & 450 scientific papers and chapters in the book. He is on editorial board of several journals and President of society of robotic urologic surgery.He serves as a member of scientific committee in American Urology Association, World Congress of Endourology & SIU. Dr. Hemal has been the recipient of many academic distinctions and awards. He has been awarded three times by President of India including the most prestigious honor a physician can receive, the “Dr. B.C. Roy Award,” in 2004 for his contributions in the field of cost-effective minimally invasive surgery and highest civilian honor “Padma-Shree” in 2007 for development of robotic urologic surgery. Other prestigious awards to his credit are Urologist of the Decade award, Guest Scholar of the American College of Surgeons, SIU scholar and Fulbright scholar. Dr. Hemal is consistently included in Best Doctors of America, Top Doctors of America, Top Prostate Cancer Specialists and Who’s Who in the World for past several years.