Does adequate bladder cuff excision impact outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma.

BACKGROUND Nephroureterectomy with bladder cuff excision has been the gold standard surgical treatment for upper tract urothelial carcinoma. In this study, we determined the independent prognostic factors for upper tract urothelial carcinoma. METHODS The records of 285 consecutive patients undergoing nephroureterectomy with bladder cuff excision at our institution between 2003 and 2007 were reviewed. Kaplan-Meier survival curves were used to determine the 5-year cancer-specific survival rates for all patient groups. Cox proportional hazard regression was performed to determine the factors that had an independent impact on the survival of patients with upper tract urothelial carcinoma. RESULTS A total of 192 patients matching the inclusion criteria were enrolled in our study. The mean follow-up time was 43.81 months. We found that the female gender, a lower ureter free of invasion, and an adequate bladder cuff excision were independent factors for a better tumor recurrence-free survival rate. The pathology stage and recurrence (none, intravesical or extravesical) were independent factors for the overall survival rate. A non-adequate ureterectomy including the bladder cuff was associated with a high body mass index (BMI) and the infiltrating tumor pattern of urothelial carcinoma. CONCLUSION Nnephroureterectomy together with adequate bladder cuff excision plays an extremely important role in the surgical treatment of upper urinary tract urothelial carcinoma. Patients with incomplete resections of the bladder cuff are at increased risk of tumor recurrence.