How safe could open extravesical bladder cuff resection guarantee complete removal of ipsilateral ureteral orifice?

Objectives: The aim of this study is to report our 8-year experience in terms of the success rate of complete bladder buff resection procedures bladder cuff resection (BCR) and further oncological outcomes in patients under open extravesical BCR for the management of primary upper tract urothelial carcinoma (UTUC). Materials and Methods: We retrospectively reviewed patients with primary UTUC who undergone laparoscopic nephroureterectomy and open extravesical BCR in our center. Complete BCR procedures were not defined by any ureteral orifice remnant noted in postoperative cystoscopy surveillance. The rate of complete BCR procedures was calculated. Patients were divided into residual ureteral orifice group (RUO) and nonRUO group (NRUO) and the intravesical and local recurrences and distant metastasis were analyzed and compared across the two groups. Results: A total of 105 patients were reviewed. After operation, 67 of them (63.8%) had ipsilateral strict criteria of complete BCR procedures defined on cystoscopy. Shorter mean operative time was noted in the RUO group comparing to the NRUO group (145 ± 73 vs. 192 ± 107 min, P = 0.03). Bladder recurrence was significantly higher in the RUO group (RUO vs. NRUO: 59.7% vs. 26%, P = 0.001) during a median of 39.7 months follow-up. Most of the intravesical recurrences were superficial (94%) and more prone to be found near the RUO/scar in the RUO group rather than the NRUO group (59.7% vs. 26.3%, P = 0.04). The RUO group strongly predicted superficial intravesical recurrence (odds ratio: 4.04, 95% confidence interval: 1.57-10.37, P = 0.004). No significant difference was recorded in muscle invasive bladder tumor, local recurrence, contralateral urinary tract recurrence, or distal metastasis across the groups. Conclusions: Open extravesical BCR does not guarantee the complete removal of ipsilateral ureteral orifice. Increased risk of superficial intravesical recurrence is noted in patients with RUO.