IMPACT OF BLADDER CUFF MANAGEMENT ON ONCOLOGIC OUTCOMES FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Bladder cuff excision (BCE) is essential to maintaining oncologic control during radical nephroureterctomy (RNUx) for upper tract urothelial carcinoma (UTUC). While intravesical, extravesical, and endoscopic methods are widely utilized, their efficacy in comparison to each other remains controversial. In this systematic review and metanalysis, we aimed to compare oncologic outcomes between different methods of BCE. We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies comparing oncologic outcomes of RNUx for UTUC based on different methods of bladder cuff management. Our primary outcomes were intravesical recurrence rate (IVR), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS). Meta-analysis was performed comparing hazard ratios and recurrence rates between different BCE techniques A total of 46 studies were included for analysis, 39 studies from initial database search and addtional 7 from reviewing references in included studies. Techniques for BCE were categorized as open intravesical, open extravesical, endoscopic, or laparoscopic extravesical. When compared to both laparoscopic and open extravesical BCE, open intravesical BCE showed superior IVRFS (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.14-1.51) but no difference in IVR or RFS. Subgroup analysis demonstrated that this effect was primarily driven by open extravesical BCE, which showed significantly worse IVRFS (HR 2.48, 95% CI 1.20-1.59). In contrast, no significant difference in IVR, IVRFS, or RFS was found between endoscopic BCE or laparoscopic extravesical BCE compared to open intravesical BCE. Similarly, there was no significant difference between extravesical BCE and endoscopic BCE. Extravesical BCE is associated with worse IVRFS compared to open intravesical BCE. Endoscopic and open intravesical BCE show equivalent rates of IVR, IVRFS, and RFS. [ABSTRACT FROM AUTHOR]