Mp44-19 the Tetrafecta Composite Outcome in Nephroureterectomy for Upper Tract Urothelial Carcinoma

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP44)1 May 2024MP44-19 THE TETRAFECTA COMPOSITE OUTCOME IN NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Maxwell Sandberg, Parth Thakker, Rory Ritts, Megan Escott, Mary Namugosa, Timothy O'Rourke, Alejandro Rodriguez, and Ashok Hemal Maxwell SandbergMaxwell Sandberg , Parth ThakkerParth Thakker , Rory RittsRory Ritts , Megan EscottMegan Escott , Mary NamugosaMary Namugosa , Timothy O'RourkeTimothy O'Rourke , Alejandro RodriguezAlejandro Rodriguez , and Ashok HemalAshok Hemal View All Author Informationhttps://doi.org/10.1097/01.JU.0001009508.69111.d0.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy (RNU) is the gold-standard treatment for UTUC. Surgical approaches include robotic (rRNU), laparoscopic (lRNU), or open (oRNU). The "tetrafecta" (TTF) of RNU is thought to be associated with improved patient complications and survival outcomes, particularly with rRNU over lRNU and oRNU. However, the true benefits of this composite outcome remain controversial. The objective of this study was to compare morbidity and mortality postoperatively from RNU using the TTF composite outcome, with a focus on surgical approach. METHODS: Patients who underwent RNU for UTUC were retrospectively reviewed at our institution between 2006-present. Patients were divided into 3 groups based on surgical approach and their outcomes were recorded. Complications were graded based on the Clavien-Dindo Classification system. The TTF was defined as having all the following: lymph node dissection, negative surgical margins, a true blader cuff, and no post-operative complications. Analysis included independent samples t-test, chi-squared test, and Kaplan-Meier survival. RESULTS: 250 RNU were completed during the study (145 rRNU, 62 lRNU, 43 oRNU; Figure 1A). TTF was achieved in 85/250 (34%) patients. The TTF was more likely to be achieved in patients undergoing rRNU compared to lRNU or oRNU 72/145 (50%) vs. 10/62 (16%) vs. 3/43 (7%), p<0.001. Recurrence-free survival (p=0.280) and overall survival postoperatively (p=0.445) did not differ with the TTF. When plotted on a Kaplan-Meier survival curve, no difference existed in cancer-specific mortality based on the tetrafecta (Figure 1B; p=0.076). Overall complication rate was lowest in rRNU and lRNU compared to oRNU (p<0.001), Average Clavien-Dindo grade was also highest with oRNU (2.31) relative to rRNU (1.22) and lRNU (1.39; p<0.001). CONCLUSIONS: The TTF was more likely to be achieved in patients undergoing rRNU. Current literature encourages the adoption of composite outcomes, however given similar survival parameters, the utility of TTF for RNU remains in question. Surgical practice changes to RNU, such as operative approach based on composite outcomes should be done with caution. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e739 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maxwell Sandberg More articles by this author Parth Thakker More articles by this author Rory Ritts More articles by this author Megan Escott More articles by this author Mary Namugosa More articles by this author Timothy O'Rourke More articles by this author Alejandro Rodriguez More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...