Preoperative Renal Impairment as an Independent Determinant of Poor Survival After Concomitant Laparoscopic Radical Cystectomy and Nephroureterectomy.

OBJECTIVE: This study was designed to evaluate the impact of preoperative renal function on survival after laparoscopic radical cystectomy (RC) with/without concomitant nephroureterectomy (RCNU) for urothelial carcinoma (UC). METHODS: This retrospective cohort study matched 36 patients undergoing RCNU for synchronous bladder and upper tract urothelial carcinoma 1:2 to 72 RC-alone controls. Perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), and renal function (eGFR) were analyzed. Cox regression identified independent prognostic factors for OS. RESULTS: Baseline characteristics were well-balanced. The RCNU group had a significantly lower median preoperative eGFR (47.9 vs. 77.5 mL/min/1.73 m2, P = 0.003). Multivariable analysis identified preoperative eGFR <60 mL/min/1.73 m2 (hazard ratio [HR] = 1.933, 95% confidence interval [CI] 1.067-3.503, P = 0.030) and lymph node metastasis (HR = 4.022, 95% CI 2.182-7.413, P < 0.001) as independent predictors of worse OS. Although RCNU was associated with worse OS in univariable analysis, it was not an independent prognostic factor after adjustment (P = 0.077). No significant difference in RFS was observed (P = 0.315). Sensitivity analysis after re-matching for baseline renal function confirmed that RCNU was no longer associated with OS (HR = 1.82, 95% CI 0.91-3.64, P = 0.092), whereas preoperative eGFR <60 remained a significant predictor (HR = 2.27, 95% CI 1.13-4.54, P = 0.021). CONCLUSIONS: Preoperative renal impairment (eGFR < 60 mL/min/1.73 m2) is a primary independent determinant of poor survival in patients undergoing radical surgery for UC, surpassing the prognostic contribution of the surgical procedure itself. Lymph node metastasis represents another crucial independent prognostic factor. These findings highlight the imperative for comprehensive preoperative renal function assessment and renal preservation-oriented strategies in the management of UC.