Perioperative Instrumentation and Factors that Impact Intravesical Urothelial Carcinoma Recurrence After Nephroureterectomy

Abstract

Background: Urothelial carcinoma of the ureter and renal pelvis has a tendency to recur following surgical intervention. A leading theory attributes this pattern to tumor seeding occurring during diagnostic or surgical procedures. Instruments commonly used during diagnostic and surgical intervention, such as ureteral stents, may influence recurrence rates.

Methods: Electronic medical records of 201 patients with a history of upper tract urothelial carcinoma and nephroureterectomy were reviewed. Seventy clinical factors were recorded and organized into pre-, peri-, and post-surgical categories. Of these variables pre-procedural ureteroscopy, access sheath use, stent placement, and biopsy were analyzed in connection to recurrence. Perioperative factors analyzed included the presence of a stent during the nephroureterectomy and the surgical approach (open vs. minimally invasive). Odds ratios (OR) and statistical significance (p-value) were used to determine potential correlation.

Results: Of the 201 patients, 105 (52.2%) experienced recurrence. Pre-procedural biopsy (OR 0.87, p=0.67), pre-procedural ureteroscopy (OR 0.96, p = 0.90), and surgical approach (OR 1.04, p=0.90) demonstrated no significant impact on recurrence. Use of an access sheath during the diagnostic procedure (OR 1.22, p=0.53) and pre-procedural stent placement (OR 1.26, p=0.45) suggested an increase in recurrence, although not statistically significant. The presence of a stent during nephroureterectomy demonstrated a higher risk of recurrence (OR 1.8) and neared statistical significance (p=0.05).

Conclusion: These findings suggest that certain perioperative factors such as the presence of a stent during nephroureterectomy may contribute to increased recurrence rates through mechanisms such as tumor seeding. Our study approaches statistical significance. Analysis of a larger cohort is anticipated to strengthen this association.