Bladder cuff excision techniques in upper urinary tract urothelial carcinoma: A multicenter comparative study

Purpose: To determine the most effective technique for bladder cuff excision in treating upper urinary tract urothelial carcinoma. Materials and methods: We conducted a retrospective analysis of 1172 urinary tract urothelial carcinoma patients across 19 hospitals in Taiwan between July 1988 and August 2022, focusing on surgeries performed from January 11, 2001, to November 22, 2021. Patients were divided into 3 groups: open incision, transurethral, and laparoscopic (LPS)/robotic/laparoendoscopic single-site surgery (LESS). The open incision group comprised 1056 patients, while the remaining patients were divided among the other techniques. Results: Univariate analysis revealed that LPS/robotic/LESS resulted in better overall survival compared with open incision (hazard ratio [HR] = 0.612; 95% confidence interval [CI], 0.448–0.836; P = 0.002). In terms of bladder recurrence-free survival, the transurethral group showed a lower bladder recurrence rate than the open incision group (HR = 0.697; 95% CI, 0.505–0.961; P = 0.028). However, multivariate analysis indicated that the transurethral method had worse outcomes than the open incision for cancer-specific survival (HR = 2.347; 95% CI, 1.115–4.942; P = 0.025) and disease-free survival (HR = 1.831; 95% CI, 1.079–3.108; P = 0.025). Surprisingly, the transurethral group showed better bladder recurrence-free survival (HR = 0.606; 95% CI, 0.414–0.888; P = 0.01). Conclusion: Based on these findings, LPS/robotic/LESS appeared to be the preferred choice for bladder cuff excision.