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The following is a summary of “The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry,” published in the August 2024 issue of Urology by Yong et al.

This study aimed to evaluate the impact of bladder cuff excision and the associated techniques on outcomes following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

The researchers conducted a multicenter, international, retrospective analysis using data from the ROBotic Surgery for Upper Tract Urothelial Cancer Study (ROBUUST) 2.0 registry. This registry included 1,718 patients who underwent RNU for UTUC between 2015 and 2023 at 17 centers across the United States, Europe, and Asia. The study focused on two key variables: whether bladder cuff excision was performed and the technique used, which could be formal excision or alternative methods such as the pluck technique or stripping/intussusception technique. Outcomes were analyzed through multivariate and survival analyses to compare the effectiveness of these approaches.

Among the cohort, 90% (1,540/1,718) of patients underwent formal bladder cuff excision, in line with EAU and AUA guidelines. In contrast, only 4% (68/1,718) underwent resection using alternative techniques, while 6% (110/1,718) did not have the bladder cuff excised at all. The median follow-up period was 24 months (IQR 9–44). Comparative analyses revealed no significant differences in oncologic or survival outcomes, including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis-free survival (MFS), overall survival (OS), or cancer-specific survival (CSS) between formal bladder cuff excision and other techniques. Nevertheless, bladder cuff excision, irrespective of technique, was associated with a reduced risk of bladder-specific recurrence compared to no excision. No significant differences were observed in RFS, MFS, OS, or CSS among patients who underwent bladder cuff excision, those who used alternative techniques, and those who did not have the bladder cuff excised.

Bladder cuff excision is associated with improved bladder recurrence-free survival, particularly when any form of excision is performed compared to no excision, provided the intramural ureter and ureteral orifice are also removed. However, the influence of bladder cuff excision on metastasis-free survival, overall survival, and cancer-specific survival remains inconclusive. These findings suggest that while bladder cuff excision enhances bladder recurrence outcomes, its effect on other survival metrics requires further investigation.

Source: sciencedirect.com/science/article/abs/pii/S1078143924005015