Introduction: We sought to assess the long-term results of conservative treatment for upper urinary tract carcinoma (UUTC) with regard to tumour recurrence and preservation of renal unit. Methods: From October 1987 to January 2014, 65 patients (median age 68 years) were diagnosed with UUTC and underwent endoscopic and open surgical techniques. Thirteen patients had bilateral disease and one had a single kidney. The primary approach was endoscopic in 37 reno-ureteral units (20 percutaneous resections, 17 ureteroscopies ). Open surgery was performed in 19 cases. A total of 20 patients received mitomycin C. Results: Superficial stage pTa or T1 was noted in 37 patients, infiltrating stage pT2 and pT3 in seven and inverted papilloma in one. The stage of the tumour was impossible to classify in 20. With a median followup of 75.12 months (interquartile range [IQR] 144.71-17.41), the kidney preservation, recurrence, specific survival, and global survival rates were 78.5% (51/65), 40.0% (26/65), 92.3% (60/65), and 69.2% (45/65), respectively. From the patients who had recurrence, 15 were salvaged with radical nephroureterectomy (RNU). The bladder tumour recurrence rate after the surgery was 30.76% (20/65). At the end of the followup, five patients had died of UUTC progression and 16 from other causes. Postoperative complications included one case of fistula, one case of stricture, and one case of nephrectomy due to bleeding. Conclusions: In selected cases, conservative management is a safe and feasible alternative to RNU, with the advantage of renal unit preservation.
IntroductionUpper urinary tract carcinoma (UUTC) is uncommon and accounts for 5-10% of all urothelial carcinomas.1,2 Radical nephroureterectomy (RNU) with excision of the bladder cuff is the gold standard treatment for localized disease, regardless of the location of the tumour in the upper urinary tract.An interest in the conservative surgery, including endoscopic ablation and segmental resection, has emerged in recent years as an alternative for patients with UUTC and renal insufficiency, solitary functional kidney, comorbidities, or bilateral tumour, accounting for approximately 2-5% of UUTC patients.
3The elective cases for nephron-sparing surgery are considered in patients with low-grade, low-stage, unifocal, small tumours. In addition, the patient has to accept close followup because of the risk of recurrence, which is the main disadvantage of this treatment. 4 After RNU, the presence of a solitary kidney can lead to a renal insufficiency stage, which is associated with an increase in cardiovascular events and, therefore, in overall mortality. 4 It is well-documented that glomerular filtration rate decreases after RNU, with a mean of 24%, according to the outcomes of a recent multicentre analysis by Kaag et al. 5 These changes in renal function may affect eligibility for adjuvant cisplatin based-therapy. 5 Moreover, multifocal recurrence of UUTC in the contralateral side has renewed the interest in conservative treatment in elective cases. F...
