Quality indicators for the management of high-risk upper tract urothelial carcinoma requiring radical nephroureterectomy
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Quality indicators for the management of high-risk upper tract urothelial carcinoma requiring radical nephroureterectomy. / König, Frederik; Shariat, Shahrokh F; Karakiewicz, Pierre I; Mun, Dong-Ho; Rink, Michael; Pradere, Benjamin.
in: CURR OPIN UROL, Jahrgang 31, Nr. 4, 01.07.2021, S. 291-296.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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T1 - Quality indicators for the management of high-risk upper tract urothelial carcinoma requiring radical nephroureterectomy
AU - König, Frederik
AU - Shariat, Shahrokh F
AU - Karakiewicz, Pierre I
AU - Mun, Dong-Ho
AU - Rink, Michael
AU - Pradere, Benjamin
N1 - Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - PURPOSE OF REVIEW: The purpose of this article was to identify quality indicators for an optimized management of high-risk upper tract urothelial carcinoma (UTUC) requiring radical nephroureterectomy (RNU).RECENT FINDINGS: RNU with bladder cuff resection is the standard treatment of high-risk UTUC. For the bladder cuff resection, two main approaches are accepted: transvesical and extravesical. Lymph node dissection following a dedicated template should be performed in all high-risk patients undergoing RNU as it improves tumour staging and possibly survival. Postoperative bladder instillation of single-dose chemotherapy should be administered after RNU to decrease the risk of intravesical tumour recurrence. Perioperative systemic chemotherapy should always be considered for advanced cancers. Although level-1 evidence is available for adjuvant platinum-based chemotherapy, neoadjuvant regimens are still being evaluated.SUMMARY: Optimal management of high-risk UTUC requires evidence-based reproducible quality indicators in order to allow guidance and frameworks for clinical practices. Adherence to quality indicators allows for the measurement and comparison of outcomes that are likely to improve prognosis. Based on the literature, we found four evidence-based accepted quality indicators that are easily implementable to improve the management of high-risk UTUC patients treated with RNU: adequate management of the distal ureter/ bladder cuff, template-based lymph node dissection, single-shot postoperative intravesical chemotherapy, and perioperative systemic treatment.
AB - PURPOSE OF REVIEW: The purpose of this article was to identify quality indicators for an optimized management of high-risk upper tract urothelial carcinoma (UTUC) requiring radical nephroureterectomy (RNU).RECENT FINDINGS: RNU with bladder cuff resection is the standard treatment of high-risk UTUC. For the bladder cuff resection, two main approaches are accepted: transvesical and extravesical. Lymph node dissection following a dedicated template should be performed in all high-risk patients undergoing RNU as it improves tumour staging and possibly survival. Postoperative bladder instillation of single-dose chemotherapy should be administered after RNU to decrease the risk of intravesical tumour recurrence. Perioperative systemic chemotherapy should always be considered for advanced cancers. Although level-1 evidence is available for adjuvant platinum-based chemotherapy, neoadjuvant regimens are still being evaluated.SUMMARY: Optimal management of high-risk UTUC requires evidence-based reproducible quality indicators in order to allow guidance and frameworks for clinical practices. Adherence to quality indicators allows for the measurement and comparison of outcomes that are likely to improve prognosis. Based on the literature, we found four evidence-based accepted quality indicators that are easily implementable to improve the management of high-risk UTUC patients treated with RNU: adequate management of the distal ureter/ bladder cuff, template-based lymph node dissection, single-shot postoperative intravesical chemotherapy, and perioperative systemic treatment.
KW - Carcinoma, Transitional Cell/surgery
KW - Humans
KW - Kidney Neoplasms/surgery
KW - Neoplasm Recurrence, Local/epidemiology
KW - Nephroureterectomy
KW - Quality Indicators, Health Care
KW - Retrospective Studies
KW - Ureter/surgery
KW - Ureteral Neoplasms/surgery
U2 - 10.1097/MOU.0000000000000895
DO - 10.1097/MOU.0000000000000895
M3 - SCORING: Review article
C2 - 33973537
VL - 31
SP - 291
EP - 296
JO - CURR OPIN UROL
JF - CURR OPIN UROL
SN - 0963-0643
IS - 4
ER -