Robot-assisted radical cystectomy and en bloc nephroureterectomy for synchronous upper and lower tract urothelial carcinoma: A multi-center case series

Vishali Sharma; Elaina Gubbay; Kimberley Chan; Ross Warner; Yogit Wagh; Prabhat Narayan; Karel Decaestecker; Jeremy Teoh; Philip Charlesworth; Ben Pullar; Nikhil Vasdev; Vishali Sharma; Elaina Gubbay; Kimberley Chan; Ross Warner; Yogit Wagh; Prabhat Narayan; Karel Decaestecker; Jeremy Teoh; Philip Charlesworth; Ben Pullar; Nikhil Vasdev

doi:10.3934/medsci.2026014

AIMS Medical Science

2026, Volume 13, Issue 3: 202-213. doi: 10.3934/medsci.2026014

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Research article

Robot-assisted radical cystectomy and en bloc nephroureterectomy for synchronous upper and lower tract urothelial carcinoma: A multi-center case series

1.
Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kingdom
2.
Department of Urology, Royal Berkshire Hospital, Reading, United Kingdom
3.
Department of Urology, Maria Middelares General Hospital, Ghent, Belgium
4.
Faculty of Medicine, The Chinese University of Hong Kong Medical Centre, Hong Kong, China
5.
Department of Urology, The Prince of Wales Hospital, Hong Kong, China
6.
School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom

Received: 07 April 2026 Revised: 14 August 2026 Accepted: 28 August 2026 Published: 09 September 2026

Introduction
Synchronous upper and lower urothelial carcinoma is uncommon, accounting for approximately 1.8% of patients with urothelial malignancy. Currently, there are no international guidelines for management when the conditions occur concomitantly. En bloc robot-assisted radical cystectomy (RARC) and nephroureterectomy (RANU) represent one management option for selected patients; however, available data remains limited due to the rarity of cases. We report the perioperative and short-term oncological outcomes from a multi-center cohort undergoing combined RARC and RANU.
Methods
A multi-center, retrospective review was conducted. Patients undergoing combined RARC and RANU or laparoscopic nephroureterectomy between October 2016 and May 2022 for synchronous upper and lower tract urothelial carcinoma were identified and entered into a retrospective database following written consent. Perioperative and oncological parameters were recorded and analyzed using Microsoft Excel.
Results
Five patients underwent combined RARC and RANU with three undergoing RARC and laparoscopic nephroureterectomy. Age ranged between 44 and 80 years (median 68 years). Seven had RARC with unilateral nephroureterectomy, and one had RARC, bilateral RANU, and pelvic exenteration. Median console time was 280 minutes, and the median overall operative time was 420 minutes. Three patients had intracorporeal ileal conduit urinary diversion. No cases required conversion to open surgery, and mean blood loss was 201 mL. Mean inpatient stay was 9.9 days. Three patients experienced minor postoperative complications (Clavien-Dindo grade ≤ II). Surgical margins were clear in all cases, and there was no 30- or 90-day mortality. During the mean 15.5-month follow-up, three patients developed metastatic disease progression with an average time to metastasis of 10.3 months. All patients with metastatic recurrence died from cancer-related disease progression during follow up. One patient had nodal recurrence but is in remission after adjuvant chemotherapy.
Conclusion
Concurrent RARC and RANU is a technically feasible management option in selected patients; however, the risk of metastatic recurrence and cancer-related mortality remains significant. Further prospective studies are required to optimize patient selection, assess long-term oncological outcomes, and clarify the role of perioperative systemic therapy in the management of pan-urothelial carcinoma.
- cystectomy,
- nephroureterectomy,
- robot-assisted surgery,
- bladder cancer,
- ureteral cancer
Citation: Vishali Sharma, Elaina Gubbay, Kimberley Chan, Ross Warner, Yogit Wagh, Prabhat Narayan, Karel Decaestecker, Jeremy Teoh, Philip Charlesworth, Ben Pullar, Nikhil Vasdev. Robot-assisted radical cystectomy and en bloc nephroureterectomy for synchronous upper and lower tract urothelial carcinoma: A multi-center case series[J]. AIMS Medical Science, 2026, 13(3): 202-213. doi: 10.3934/medsci.2026014

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Abstract

Introduction

Synchronous upper and lower urothelial carcinoma is uncommon, accounting for approximately 1.8% of patients with urothelial malignancy. Currently, there are no international guidelines for management when the conditions occur concomitantly. En bloc robot-assisted radical cystectomy (RARC) and nephroureterectomy (RANU) represent one management option for selected patients; however, available data remains limited due to the rarity of cases. We report the perioperative and short-term oncological outcomes from a multi-center cohort undergoing combined RARC and RANU.

Methods

A multi-center, retrospective review was conducted. Patients undergoing combined RARC and RANU or laparoscopic nephroureterectomy between October 2016 and May 2022 for synchronous upper and lower tract urothelial carcinoma were identified and entered into a retrospective database following written consent. Perioperative and oncological parameters were recorded and analyzed using Microsoft Excel.

Results

Five patients underwent combined RARC and RANU with three undergoing RARC and laparoscopic nephroureterectomy. Age ranged between 44 and 80 years (median 68 years). Seven had RARC with unilateral nephroureterectomy, and one had RARC, bilateral RANU, and pelvic exenteration. Median console time was 280 minutes, and the median overall operative time was 420 minutes. Three patients had intracorporeal ileal conduit urinary diversion. No cases required conversion to open surgery, and mean blood loss was 201 mL. Mean inpatient stay was 9.9 days. Three patients experienced minor postoperative complications (Clavien-Dindo grade ≤ II). Surgical margins were clear in all cases, and there was no 30- or 90-day mortality. During the mean 15.5-month follow-up, three patients developed metastatic disease progression with an average time to metastasis of 10.3 months. All patients with metastatic recurrence died from cancer-related disease progression during follow up. One patient had nodal recurrence but is in remission after adjuvant chemotherapy.

Conclusion

Concurrent RARC and RANU is a technically feasible management option in selected patients; however, the risk of metastatic recurrence and cancer-related mortality remains significant. Further prospective studies are required to optimize patient selection, assess long-term oncological outcomes, and clarify the role of perioperative systemic therapy in the management of pan-urothelial carcinoma.

Abbreviations

RANU

Robot-assisted nephroureterectomy

RARC

Robot-assisted radical cystectomy

Ethics approval and consent to participate

This study was a retrospective, multicenter case series and used anonymized data collected during routine clinical care. In accordance with institutional and national regulations, ethics approval was not required. No identifiable patient information was used, and written consent was obtained from all patients.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflict of interest

The author declares no conflict of interest.

References

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