Blogger's Note: this will be of interest to Lynch Syndrome patients/UTUC/surveillance-diagnostics
Abstract
Ann Surg Oncol. 2013 May 10
BACKGROUND:
Little is known about the effects of diagnostic ureteroscopy on intravesical recurrence
after nephroureterectomy.
METHODS:
This
study was designed to determine the
effect of diagnostic ureteroscopy
on intravesical recurrence after nephroureterectomy. From 2004 to 2010,
446 patients underwent nephroureterectomy for
upper urinary tract cancer
at our tertiary medical center. We included 115 patients who underwent
preoperative diagnostic ureteroscopy and 281 patients who did not. This
study analyzed the impact of the reported risk factors and diagnostic
ureteroscopy for
intravesical (bladder) recurrence after nephroureterectomy by
multivariate Cox regression model.
RESULTS:
The rates of
metastasis and cancer-specific mortality did not differ significantly
between the two groups. Diagnostic ureteroscopy was associated with a
higher incidence of intravesical recurrence in patients with (p = 0.02)
and without (p = 0.016) a previous history of bladder cancer. Ureter
tumor biopsy (p = 0.272) and ureter involvement (p = 0.743) were not
associated with the rate of intravesical recurrence in this study.
Multivariate Cox regression analysis showed that only bladder cancer
history (p < 0.001), multifocal tumor (p = 0.05), and diagnostic
ureteroscopy (p = 0.05) were independently associated with intravesical
recurrence.
CONCLUSIONS:
Diagnostic ureteroscopy for
upper urinary tract cancer was not associated with metastasis and
cancer-specific mortality.
However, ureteroscopy was associated with an
increased incidence of intravesical tumor recurrence. Methods of
prevention should be considered to decrease intravesical recurrence and
avoid repeated surgical interventions or the development of advanced
bladder disease in patients at risk.
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