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Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review

Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review
Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review

Surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC) has significantly changed over the past two decades. Data for several new surgical techniques, including nephron-sparing surgery (NSS), is emerging. The study systematically reviewed the literature comparing (randomised and observational studies) surgical and oncological outcomes for various surgical techniques MEDLINE, EMBASE, Cochrane Library, CINAHL, British Nursing Index, AMED, LILACS, Web of Science, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, ISI proceedings, and PubMed were searched to identify suitable studies. Data were extracted from each identified paper independently by two reviewers (B.R. and B.S.) and cross checked by a senior member of the team. The data analysis was performed using the Cochrane software Review manager version 5. Comparable data from each study was combined in a meta-analysis where possible. For dichotomous data, odds ratios with 95% confidence intervals (CIs) were estimated based on the fixed-effects model and according to an intention-to-treat analysis. If the data available were deemed not suitable for a meta-analysis it was described in a narrative fashion. One randomised control trial (RCT) and 19 observational studies comparing open nephroureterectomy (ONU) and laparoscopic NU (LNU) were identified. The RCT reported the LNU group to have statistically significantly less blood loss (104 vs 430 mL, P < 0.001) and mean time to discharge (2.30 vs 3.65 days, P < 0.001) than the ONU group. At a median follow-up of 44 months, the overall 5-year cancer-specific survival (CSS; 89.9 vs 79.8%) and 5-year metastasis-free survival rates (77.4 vs 72.5%) for the ONU were better than for LNU, respectively, although not statistically significant. A meta-analysis of the observational studies favoured LNU group for lower urinary recurrence (P < 0.001) and distant metastasis. The meta-analyses for local recurrence for the two groups were comparable. One retrospective study comparing ONU with a percutaneous approach for grade 2 disease reported no significant differences in CSS rates (53.8 vs 53.3 months). Three retrospective studies compared NSS and radical NU, and reported no significant differences in overall CSS and recurrence-free survival between the two approaches. Five retrospective studies compared various techniques of en bloc excision of the lower ureter. No technique was reported to be better (operative and oncological) than any other. This review concludes that there is a paucity of good quality evidence for the various surgical approaches for UUT-TCC. The techniques have been assessed and reported in many retrospective single-centre studies favouring LNU for better perioperative outcomes and comparable oncological safety. The reported observational studies data is further supported by one RCT.

Carcinoma, Transitional Cell, Disease-Free Survival, Humans, Kidney Neoplasms, Laparoscopy, Neoplasm Recurrence, Local, Nephrectomy, Survival Rate, Ureter, Ureteral Neoplasms, Urologic Surgical Procedures, Journal Article, Research Support, Non-U.S. Gov't, Review
1464-4096
1426-1435
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Shelley, Mike
d8e43eeb-6ea1-489d-99c4-597dba47323a
Coles, Bernadette
987575f3-f84a-424b-9317-38f28d84d687
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Shelley, Mike
d8e43eeb-6ea1-489d-99c4-597dba47323a
Coles, Bernadette
987575f3-f84a-424b-9317-38f28d84d687
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da

Rai, Bhavan Prasad, Shelley, Mike, Coles, Bernadette, Somani, Bhaskar and Nabi, Ghulam (2012) Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU International, 110 (10), 1426-1435. (doi:10.1111/j.1464-410X.2012.11341.x).

Record type: Review

Abstract

Surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC) has significantly changed over the past two decades. Data for several new surgical techniques, including nephron-sparing surgery (NSS), is emerging. The study systematically reviewed the literature comparing (randomised and observational studies) surgical and oncological outcomes for various surgical techniques MEDLINE, EMBASE, Cochrane Library, CINAHL, British Nursing Index, AMED, LILACS, Web of Science, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, ISI proceedings, and PubMed were searched to identify suitable studies. Data were extracted from each identified paper independently by two reviewers (B.R. and B.S.) and cross checked by a senior member of the team. The data analysis was performed using the Cochrane software Review manager version 5. Comparable data from each study was combined in a meta-analysis where possible. For dichotomous data, odds ratios with 95% confidence intervals (CIs) were estimated based on the fixed-effects model and according to an intention-to-treat analysis. If the data available were deemed not suitable for a meta-analysis it was described in a narrative fashion. One randomised control trial (RCT) and 19 observational studies comparing open nephroureterectomy (ONU) and laparoscopic NU (LNU) were identified. The RCT reported the LNU group to have statistically significantly less blood loss (104 vs 430 mL, P < 0.001) and mean time to discharge (2.30 vs 3.65 days, P < 0.001) than the ONU group. At a median follow-up of 44 months, the overall 5-year cancer-specific survival (CSS; 89.9 vs 79.8%) and 5-year metastasis-free survival rates (77.4 vs 72.5%) for the ONU were better than for LNU, respectively, although not statistically significant. A meta-analysis of the observational studies favoured LNU group for lower urinary recurrence (P < 0.001) and distant metastasis. The meta-analyses for local recurrence for the two groups were comparable. One retrospective study comparing ONU with a percutaneous approach for grade 2 disease reported no significant differences in CSS rates (53.8 vs 53.3 months). Three retrospective studies compared NSS and radical NU, and reported no significant differences in overall CSS and recurrence-free survival between the two approaches. Five retrospective studies compared various techniques of en bloc excision of the lower ureter. No technique was reported to be better (operative and oncological) than any other. This review concludes that there is a paucity of good quality evidence for the various surgical approaches for UUT-TCC. The techniques have been assessed and reported in many retrospective single-centre studies favouring LNU for better perioperative outcomes and comparable oncological safety. The reported observational studies data is further supported by one RCT.

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More information

Accepted/In Press date: 10 May 2012
e-pub ahead of print date: 3 July 2012
Published date: November 2012
Additional Information: © 2012 BJU INTERNATIONAL.
Keywords: Carcinoma, Transitional Cell, Disease-Free Survival, Humans, Kidney Neoplasms, Laparoscopy, Neoplasm Recurrence, Local, Nephrectomy, Survival Rate, Ureter, Ureteral Neoplasms, Urologic Surgical Procedures, Journal Article, Research Support, Non-U.S. Gov't, Review

Identifiers

Local EPrints ID: 419087
URI: http://eprints.soton.ac.uk/id/eprint/419087
ISSN: 1464-4096
PURE UUID: 45e74838-c411-4cea-9544-827f4852470f

Catalogue record

Date deposited: 29 Mar 2018 16:30
Last modified: 13 Mar 2019 18:44

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