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 standardsurgical treatment for upper tract urothelial carcinoma. In this study, wedetermined the independent prognostic factors for upper tract urothelial carcinoma.Methods: The records of 285 consecutive patients undergoing nephroureterectomywith bladder cuff excision at our institution between 2003 and 2007 werereviewed. Kaplan-Meier survival curves were used to determine the 5-yearcancer-specific survival rates for all patient groups. Cox proportional hazardregression was performed to determine the factors that had an independentimpact on the survival of patients with upper tract urothelial carcinoma.Results: A total of 192 patients matching the inclusion criteria were enrolled in ourstudy. The mean follow-up time was 43.81 months. We found that the femalegender, a lower ureter free of invasion, and an adequate bladder cuff excisionwere independent factors for a better tumor recurrence-free survival rate. Thepathology stage and recurrence (none, intravesical or extravesical) wereindependent 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 anextremely important role in the surgical treatment of upper urinary tracturothelial carcinoma. Patients with incomplete resections of the bladder cuffare at increased risk of tumor recurrence.