Introduction: Patients with recurrent high grade and/or muscle invasive bladder cancer and concomitant upper urinary tract disease such as urothelial tumors or afunctional hydronephrotic kidneys may be candidates for concurrent radical nephroureterectomy (RNU) and radical cystectomy (RC). However, the outcomes of the procedures are not well established in the literature. Here we report the characteristics and perioperative outcomes of patients undergoing simultaneous RNU and RC in a national database.
Methods: We queried the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database to identify all patients undergoing concurrent radical nephroureterectomy and radical cystectomy for urothelial cancer from 2010-2018. Preoperative characteristics, 30-day postoperative outcomes and 30-day readmission rates were determined.
Results: A total of 190 patients underwent sumultaneous RNU and RC of whom 145 (76.3%) were male. The median age (IQR) was 69 (55-83) years. Of the 96 patients for which the indication for concurrent RC was able to obtained, the reasons were urothelial cancer for 85 patients and neurogenic bladder for 10 patients, and radiation cystitis in 1 patient. 6 (3.2%) patients had bilateral nephroureterectomies. 65 (34.2%) patients underwent robotic or laparoscopic portions of the procedure. Median (IQR) operative time was 380 (289-471) minutes. The median (IQR) postoperative length of stay was 8 (5-11) days. 113(59.5%) of patients had a 30-day post operative complication, with the most common being bleeding requiring a tranfusion in 99 (52.1%) patients, sepsis in 17 (8.9%) patients, and surgical site infections in 22 (11.6%) patients. Of note, 8 patients developed need for postoperative dialysis. 35 (18.4%) patients had a readmission within 30 days, which were all unplanned readmissions. Four patients (2.1%) experienced a 30-day mortality. Last, 153 (80.5%) patients were able to be discharged home, with the remaining having to be discharged to skilled nursing or rehab centers.
Conclusions: We present one of the largest published series of outcomes following concurrent RNU/RC. Even though there is a high risk of 30 day perioperative complications in these patients, the 30 day mortality rate remains comparable to other major urologic cancer procedures. A RNU/RC may be appropriate form of management in the properly selected patient.
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