Radical nephroureterectomy vs kidney sparing surgery for upper tract urothelial carcinoma in solitary kidney patients: a multi-institutional analysis of the ROBUUST 2.0 registry.
Publication Title
World journal of urology
Document Type
Article
Publication Date
9-3-2025
Keywords
Humans; Nephroureterectomy; Male; Female; Aged; Kidney Neoplasms; Carcinoma, Transitional Cell; Registries; Ureteral Neoplasms; Middle Aged; Organ Sparing Treatments; Solitary Kidney; Retrospective Studies; Nephrectomy; Survival Rate; Aged, 80 and over; Treatment Outcome; Postoperative complications; Radical nephroureterectomy; Renal insufficiency; Solitary kidney; Upper tract urothelial carcinoma.; washington; swedish
Abstract
PURPOSE: Radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) in solitary kidney patients is a rare and underreported scenario. This study aims to compare the outcomes of UTUC solitary kidney patients becoming anephric after RNU to those of patients undergoing kidney-sparing surgery (KSS).
METHODS: Data from patients with a solitary kidney were retrieved from the ROBUUST 2.0 database, a global, multicenter registry containing data on patients who underwent curative surgery for UTUC. Baseline patient demographics, disease characteristics, and surgical features were compared between RNU and KSS. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) in patients undergoing RNU, with 3-year and 5-year cutoffs applied.
RESULTS: Thirty-nine patients (76.5%) underwent RNU, whereas 12 (23.5%) underwent KSS. Despite a comparable preoperative renal function, the distribution of CKD stages differed significantly between the groups (p = 0.019). Despite a similar rate of postoperative complications, patients undergoing RNU experienced a significantly higher median LOS (p < 0.001). Among RNU patients, OS was 83.9%, CSS was 96.9%, RFS was 71.8%, and MFS was 84.4% at the 3-year follow-up. After 5 years post-surgery, OS was 73.4%, CSS was 83.1%, RFS was 59.9%, and MFS was 78.5% in the same cohort.
CONCLUSIONS: UTUC solitary kidney patients undergoing RNU or KSS face a substantial perioperative burden. Despite these challenges, our cohort demonstrated favorable oncological outcomes comparable to those reported in the existing literature.
Area of Special Interest
Kidney & Diabetes
Area of Special Interest
Cancer
Specialty/Research Institute
Urology
Specialty/Research Institute
Surgery
DOI
10.1007/s00345-025-05882-0
