Impact of Urethra-Preserving Surgery During Radical Cystectomy: An Optimal Urethral Management in the Robotic Era

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-06-26 DOI:10.1016/j.clgc.2024.102146

Kenji Zennami , Makoto Sumitomo , Takuhisa Nukaya , Masashi Takenaka , Manabu Ichino , Kiyoshi Takahara , Hitomi Sasaki , Mamoru Kusaka , Ryoichi Shiroki

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引用次数: 0

Abstract

Objectives

The optimal indication and survival benefits of prophylactic urethrectomy (PU) during radical cystectomy remain unclear. Therefore, this study aims to evaluate the impact of urethra-preserving surgery (UPS) on oncological outcome including its recurrence patterns, and to establish an optimal urethral management strategy with a novel UPS technique in the robotic era.

Patients and methods

We retrospectively analyzed 281 male patients with bladder cancer who received radical cystectomy (RC) (115 with and 166 without PU) at our institutions between 2010 and 2023. Subsequently, perioperative and oncological outcomes were assessed between propensity score-matched cohorts.

Results

Urethral recurrence (UR) occurred in 5 patients (5/166, 3.0%), all of whom underwent open-RC. Three among those (1.8%) with concomitant metastasis were died of cancer. There were no statistically significant differences between the PU and UPS groups in urethral-recurrence free survival (urethral-RFS) (P = .14), local-RFS (P = .59) and overall survival (OS) (P = .84) in the entire cohort. However, the UPS group showed significantly worse urethral-RFS (P = .008), local-RFS (P = .005) and OS (P = .03) in patients with high-risk of UR. Analysis of recurrence patterns revealed that UPS in high-risk patients significantly increased local recurrence (25.8% vs. 5.0%, P = .02). Conversely, a novel robotic-UPS technique demonstrated significantly favorable perioperative outcomes, comparable local-RFS (P = .79) and OS (P = .16) without UR (0/134, 0%) when compared to robotic-PU. Robotic-UPS also exhibited significantly better local-RFS (P =.007) and OS (P < .001) than open-UPS.

Conclusions

UR-related death was rare and PU did not show a survival benefit for the entire cohort. However, inappropriate UPS in patients at high-risk of UR may increase local recurrence which might be responsible for poor survival after UPS rather than disease progression derived from UR. The robotic-UPS has the potential to reduce unnecessary PU, urethral and local recurrence without compromising survival.

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根治性膀胱切除术中保留尿道手术的影响：机器人时代的最佳尿道管理。

目的：根治性膀胱切除术中预防性尿道切除术（PU）的最佳适应症和生存益处仍不明确。因此，本研究旨在评估保留尿道手术（UPS）对肿瘤预后（包括复发模式）的影响，并通过机器人时代的新型 UPS 技术建立最佳尿道管理策略：我们回顾性分析了2010年至2023年间在本院接受根治性膀胱切除术（RC）的281例男性膀胱癌患者（其中115例接受了PU，166例未接受PU）。随后，对倾向评分匹配队列之间的围手术期和肿瘤学结果进行了评估：5例患者（5/166，3.0%）出现尿道复发（UR），所有患者均接受了开放式尿道造影术。其中有 3 名患者（1.8%）因癌细胞转移而死亡。在整个队列中，PU 组和 UPS 组在尿道无复发生存期（urethral-RFS）（P = .14）、局部无复发生存期（Local-RFS）（P = .59）和总生存期（OS）（P = .84）方面均无统计学差异。然而，UPS 组的尿道-RFS（P = .008）、局部-RFS（P = .005）和 OS（P = .03）均明显低于 UR 高危患者。复发模式分析显示，高危患者的 UPS 会显著增加局部复发率（25.8% 对 5.0%，P = .02）。相反，一种新型的机器人 UPS 技术显示出明显良好的围手术期效果，与机器人 PU 相比，其局部 RFS（P = .79）和 OS（P = .16）与 UR（0/134，0%）相当。机器人腹腔镜手术的局部RFS（P = .007）和OS（P < .001）也明显优于开腹腹腔镜手术：结论：与 UR 相关的死亡非常罕见，PU 并未显示出对整个队列有生存益处。然而，对UR高危患者进行不适当的UPS可能会增加局部复发，这可能是UPS后生存率低的原因，而不是UR导致的疾病进展。机器人尿道前列腺电切术有可能在不影响生存的情况下减少不必要的尿道前列腺电切术、尿道和局部复发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.