Clinical Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in a Specialized Cancer Hospital of a Developing Country.

Background: Radical nephroureterectomy (RNU) remains the standard of care for managing upper tract urothelial carcinoma (UTUC). Various techniques and approaches for RNU have been practiced, yielding variable outcomes. In this study, we describe our technique of a combined endoscopic and open single-incision radical nephroureterectomy with bladder cuff. Objective: To determine outcomes of open radical nephroureterectomy (RNU) using the 'pluck' technique, in patients with localized upper tract urothelial carcinoma (UTUC). Methods: After approval from the institutional review board, the data of all upper tract urothelial carcinoma patients operated from January 2012 to June 2022 at Shaukat Khanum Memorial Cancer Hospital and Lahore General Hospital, Lahore was reviewed retrospectively. Studied variables were; Demographic characteristics, medical comorbidities, presenting concerns, and preoperative and postoperative tumour characteristics. Statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 25.0 Results: Out of the 31 included patients, the renal pelvic tumours were the commonest, noted in 18 (58.1%), and commonest stage being T2, present in 13 (41.9%) patients. During median follow up of 48 months (range, 3 to 132), 10 patients developed disease recurrence and 6 patients died during the median time of 39 months (range, 3 to 64). Estimated mean recurrence-free and overall survival was 82.10 ± 10.01 months and 114.40 ± 11.30 months, respectively. No major peri-operative complications were recorded. Five-year disease-free survival and overall survival was calculated to be 72% and 70%, respectively. Conclusion: Open Radical nephroureterectomy using the pluck technique is a safe and effective surgical option in treating patients presenting with localized upper urinary tract urothelial carcinoma.