Segmental resection of distal ureter with termino-terminal ureteral anastomosis vs bladder cuff removal and ureteral re-implantation for upper tract urothelial carcinoma: results of a multicentre study.

OBJECTIVES: To compare overall (OS), cancer-specific (CSS), recurrence free survival (RFS) and post-operative renal function among patients affected by upper tract urothelial carcinoma (UTUC) of the distal (lower lumbar and pelvic) ureter, electively treated with segmental resection and termino-terminal anastomosis (TT) vs bladder cuff removal and ureteral re-implantation (RR). PATIENTS AND METHODS: A multicentre retrospective study, including 84 patients diagnosed with UTUC of the distal ureter and treated with TT or RR, is presented. The primary endpoint was to compare TT and RR in terms of OS, CSS and RFS. As a secondary outcome we compared the post-operative creatinine values as an index of renal function in the two groups. RESULTS: Out of 521 patients with UTUC, 65 (77.4%) and 19 (22.6%) patients underwent RR and TT, respectively. Pre- and post-operative characteristics were not statistically different between the two groups. The median follow-up period was 22.7 months. Patients treated with TT and those treated with RR did not show significantly different 5yOS, 5yCSS and 5yRFS (73.7 vs 92.3%, p = 0.052, 94.7 vs 95.4%, p = 0.970, and 63.2 vs 53.9%, p = 0.489, respectively). No difference in post-operative creatinine variation emerged in association with the surgical technique (p = 0.411). CONCLUSION: Patients treated with TT or RR for UTUC showed comparable OS, CSS, RFS and post-operative renal function. Our data suggest that the bladder cuff removal is not imperative in the treatment of distal ureteral UTUC, and TT can be a safe solution in selected cases. This article is protected by copyright. All rights reserved.