Bladder Cuff Excision Boosts RFS in UTUC, Regardless of Technique

For patients with upper tract urothelial carcinoma (UTUC), bladder cuff excision (BCE) and radical nephroureterectomy (RNU) is a longstanding treatment.

A recent analysis of the ROBUUST 2.0 registry by Courtney Yong, MD, and colleagues sought to examine if the use of BCE influences outcomes after RNU for UTUC.

The multicenter, international analysis utilized data from 1718 patients who underwent RNU for UTUC between 2015 and 2023. Information was gathered on whether BCE was performed and what technique was used, including formal excision, pluck technique, or stripping/intussusception technique, along with its outcomes. Patients were placed into groups and compared using multivariate and survival analyses.

A total of 1540 (90%) patients received formal BCE, while only 68 (4%) patients underwent resection through other techniques. A bladder cuff was not excised in 110 (6%) patients.

The median follow-up was 24 months. No differences were noted in oncologic or survival outcomes including bladder recurrence-free survival, recurrence-free survival (RFS), metastasis-free survival (MFS), overall survival (OS), or cancer-specific survival (CSS) between techniques.

Excision performed using any technique was linked to a decreased risk of bladder-specific recurrence compared to patients who did not undergo excision. No difference in RFS, MFS, OS, or CSS was seen when comparing BCE with other techniques and no excision.

BCE has been shown to improve RFS regardless of technique used, but the benefit of BCE of MFS, OS, and CSS still warrants further investigation.