A 20-Year Experience With Percutaneous Resection of Upper Tract Transitional Carcinoma: Is There an Oncologic Benefit With Adjuvant Bacillus Calmette Guérin Therapy?

Rastinehad, Ardeshir R.; Ost, Michael C.; VanderBrink, Brian A.; Greenberg, Kathryn L.; El-Hakim, Assaad; Marcovich, Robert; Badlani, Gopal H.; Smith, Arthur D.

doi:10.1016/j.urology.2008.06.026

Cited by 92 publications

(64 citation statements)

References 17 publications

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“…9 Concern regarding tract seeding after a percutaneous approach is highly unlikely, standing at 0.75% in the most experienced institutes. 22 Moreover, renal unit preservation, which in this study reaches nearly 80% after a mean followup of 75 months, allows us to cope in better conditions with the risk of a contralateral tumour (6%). 23 On the other hand, the decrease of glomerular filtration rate following RNU and therefore the risk of developing complications such as chronic kidney disease, may affect eligibility for adjuvant cisplatin-based therapies, particularly in elderly patients.…”

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confidence: 62%

Conservative treatment of upper urinary tract carcinoma: Long-term results

Andrada

García

Fúnez

et al. 2017

CUAJ

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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...

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confidence: 62%

Conservative treatment of upper urinary tract carcinoma: Long-term results

Andrada

García

Fúnez

et al. 2017

CUAJ

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“…Similarly, the only data on outcomes of percutaneous management of UTUC come from retrospective series (Table 2) [58][59][60][61][62][63][64][65][66] . Overall, patients managed percutaneously had similar clinical features to those managed ureterscopically -namely low grade, small focal tumors.…”

Section: Nephron Sparing Treatments For Utucmentioning

confidence: 99%

Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management

Fiuk¹,

Schwartz²

2016

WJN

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Upper tract urothelial carcinoma (UTUC) is relatively rare compared to urothelial carcinoma of the lower tract, comprising only 5%-10% of all urothelial cancers. Although both entities share histologic properties, UTUC tends to be more invasive at diagnosis and portend a worse prognosis, with a 5 year overall mortality of 23%. To date, the gold standard management of UTUC has been radical nephroureterectomy (RNU), with nephron sparing techniques reserved for solitary kidneys or cases where the patient could not tolerate radical surgery. Limited data from these series, as well as select series where nephron-sparing endoscopic management has been offered to a broader patient base, suggest that minimally invasive, nephron sparing techniques can offer comparable oncologic and survival outcomes to RNU in appropriately selected patients. We review the current literature on the topic and discuss long term outcomes and sequelae of the gold standard treatment, RNU. We also discuss the oncologic outcomes of minimally invasive, endoscopic management of UTUC. Our goal is to provide the reader a comprehensive overview of the current state of the field in order to inform and guide their treatment decisions. Core tip: In the appropriate patient population, minimally invasive endoscopic treatment of upper tract urothelial carcinoma provides comparable oncologic and survival outcomes to the gold standard radical nephroureterectomy.

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“…En cambio, su eficacia en los tumores del TUS no está claramente demostrada en cuanto a prevención de recurrencia tras el tratamiento conservador o como tratamiento primario del CIS del tracto urinario superior (la tasa inicial de respuesta positiva de estos tumores a BCG oscila entre el 60-100%), siendo esto motivo de futuras investigaciones (26,27,28). Los agentes más comúnmente empleados son el bacilo de CalmetteGuerín (BCG), mitomicina, tiotepa, epirubicina y BCG/interferón alpha (29).…”

Section: La Urografía Por Resonancia Magnética (Rm) Está Indicada En unclassified

Descriptive analysis of a series of 32 upper urinary tract tumors in a second level hospital

et al. 2014

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Análisis descriptivo de una serie de 32 tumores del tracto urinario superior en un hospital de segundo nivel ResumenIntroducción: El objetivo del estudio es analizar, basándonos en los pacientes tratados en nuestro servicio de tumores del tracto urinario superior, las características epidemiológicas y clínicas así como las variables que han influido en la evolución y mortalidad de estos pacientes. Materiales y Métodos: Se analizaron retrospectivamente 32 pacientes diagnosticados de tumores del tracto urinario superior en el Hospital comarcal Santa Ana de Motril (Granada), en el periodo comprendido entre enero del 2003 y diciembre del 2013. Resultados: La edad media fue de 72,25 años. El 75% eran hombres y el 25% mujeres. El 71.9% eran hipertensos, el 46.9% fumadores. El 18.8% presentaba un tumor vesical en el momento del diagnóstico. El 90.6% debutó con hematuria. El 53.1% se localizó en el lado derecho y el 43.8% en el izquierdo. El 25% se desarrollaron en los cálices, el 46.8% en la pelvis renal y el 50% a nivel ureteral. El estadio anatomopatológico al diagnóstico fue: 6.3% Ta, 25% T1, 28.1% T2, 37.5% T3 y 3.1% T4. El 21.9% eran grado I, el 34.4% grado II y el 43.8% grado III. No se observó recidiva tumoral en ningún paciente, siendo la mortalidad cáncer -específica del 0%. En 8 pacientes se diagnosticó un tumor vesical durante su seguimiento. La media de estancia hospitalaria fue de 7 días. Conclusiones: A pesar de ser una casuística limitada los resultados obtenidos son satisfactorios independientemente de la técnica quirúrgica empleada, al ser la supervivencia libre de enfermedad en el periodo de seguimiento del 100% y la mortalidad cáncer-específica del 0%. AbstractIntroduction: The aim of the study is to analyze, based on patients treated in our department of upper urinary tract tumors, epidemiological and clinical characteristics as well as the variables that have influenced the evolution and mortality of these patients Material and methods: 32 patients diagnosed of upper urinary tract tumors in Santa Ana Hospital of Motril (Granada) between January 2003 and December 2013 were retrospectively analyzed. Results: The mean age was 72.25 years. 75% were male and 25% female. 71.9% were hypertensive, 46.9% were smokers. 18.8% had a bladder tumor at diagnosis. 90.6% debuted with hematuria.53.1% was located on the right side and 43.8% on the left. 25% were developed in the chalices, 46.8% in the renal pelvis and ureteral 50%.The pathologic stage at diagnosis: 6.3% Ta, 25% T1, 28.1% T2, 37.5% T3 and 3.1% T4. 21.9% were grade I, grade II 34.4% and 43.8% grade III. No tumor recurrence was observed in any patient being cancer -specific mortality of 0%. In 8 patients bladder tumor was diagnosed during follow-up. The mean hospital stay was 7 days. Conclusions: Despite being limited casuistry the results are satisfactory regardless of the surgical technique used, being disease-free survival in the follow-up period of 100% and cancer-specific mortality of 0%. Enviado: 02-12-2014 Revisado: 22-12-2014 Aceptado: 29-12-...

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A 20-Year Experience With Percutaneous Resection of Upper Tract Transitional Carcinoma: Is There an Oncologic Benefit With Adjuvant Bacillus Calmette Guérin Therapy?

Cited by 92 publications

References 17 publications

Conservative treatment of upper urinary tract carcinoma: Long-term results

Conservative treatment of upper urinary tract carcinoma: Long-term results

Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management

Descriptive analysis of a series of 32 upper urinary tract tumors in a second level hospital

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