Comparison of Open Nephroureterectomy and Open Conservative Management of Upper Urinary Tract Transitional Cell Carcinoma

Abstract

Introduction: The treatment preserving the kidney for upper urinary tract (UUT) transitional cell carcinoma (TCC) is still controversial. We aimed to elucidate the results of open conservative surgery and compare them with the results of radical nephroureterectomy (RNU). Patients and Methods: The study included 107 patients with UUT TCC treated by open conservative surgery (21 patients) or nephroureterectomy (86 patients). Epidemiological, clinical and pathological characteristics of patients as well as 5-year survival rates were compared between groups. Results: Patients treated by conservative surgery had a significantly higher rate of bilateral tumors (38% vs. 3%, p = 0.0001) and smaller tumor size than those treated by radical operations (2.60 ± 1.24 vs. 3.99 ± 3.94 cm, p = 0.060). Five-year survival rates for patients treated by conservative and radical surgery were 59 and 55%, respectively. Within the group of patients treated by conservative surgery, 5-year overall survival rates of patients operated due to imperative and elective indications were 41 and 75%, respectively. In univariate analysis, RNU was a statistically significant predictor of poorer outcome of the disease in comparison with conservative surgery (HR = 2.2, 95% CI 1.1–4.6, p = 0.030). Conclusions: The mode of operation affects the outcome of UUT TCC patients, in addition to factors such as tumor grade, stage and size.

Oncologic outcomes and prognostic impact of urothelial recurrences in patients undergoing segmental and total ureterectomy for upper tract urothelial carcinoma

“…17 When analyzing patients exclusively with SU, published series have shown much more encouraging outcomes. 18,19 Colin and colleagues, in the largest published study, evaluated 52 distal SU patients and 416 NU patients, demonstrating similar 5-year DSS (87.9% vs. 86.3%, p = 0.99). 20 Jedres and colleagues performed a Surveillance, Epidemiology, and End Results (SEER)-database review of 569 SU and 1222 NU patients and described similar oncologic outcomes between groups (5-year DSS 86.6% vs. 82.2%, p = 0.05).…”

Kidney-sparing Management Versus Nephroureterectomy for Upper Tract Urothelial Carcinoma: a Systematic Review and Meta-analysis

“…Hence, we selected the one with more areas and patients. After rounds of screening, twenty-three studies including 1587 KS and 3996 NU patients were enrolled meta-analysis at last (Hall et al, 1998;Shiraishi et al, 2003;Chen et al, 2005;Roupret et al, 2006;Giannarini et al, 2007;Lehmann et al, 2007;Lucas et al, 2008;Dragicevic et al, 2009;Gadzinski et al, 2010;Jeldres et al, 2010;Raymundo et al, 2011;Bin et al, 2012;Bing-bing et al, 2012;Colin et al, 2012;Grasso et al, 2012;Bagrodia et al, 2013;Cutress et al, 2013;Fajkovic et al, 2013;Klatte et al, 2013;Dalpiaz et al, 2014;Fukushima et al, 2014;Hoffman et al, 2014;Hung et al, 2014). All included studies were retrospective comparative study; no randomized controlled trials were identified.…”

Survival of patients with upper urinary tract urothelial carcinoma after nephroureterectomy and risk factors for bladder cancer

“…Ova veza uslovljava mnoge specifičnosti, od kojih neke, upravo, upućuju na primenu konzervirajuće operacije: renalna insuficijencija, zastupljenost bilateralnih formi tumora i najveći broj tumora niskog ili srednjeg stepena maligniteta [118,119]. Petković je rezultatima prvih 26 konzervirajućih operacija zbog tumora gornjeg urotelijuma pobudio veliko interesovanje u svetu [120].…”

“…Što radikalniji hirurški postupak u konzervirajućoj hirurgiji značajno povećava izgled na uspeh tog lečenja [118]. U uporednoj analizi epidemioloških i kliničko-patoloških karakteristika, između pacijenata operisanih konzervirajućom i radikalnom operacijom, Dragičević je pokazao da pacijenti operisani konzervirajućom operacijom imaju manje tumore, tumore nižeg stepena maligniteta i stadijuma anatomskog razvoja, kao i češće pojavu bilateralnih tumora [119]. Rezultati analize uspešnosti konzervirajućih i radikalnih operacija praćeni kao stopa petogodišnjeg preživljavanja pokazali su da nema statistički značajne razlike u preživljavanju pacijenata između ove dve grupe, mada je poređenje izvedeno na uzorcima različite veličine [120].…”

“…Kod operisanih konzervirajućim operacijama stadijum i stepen maligniteta su niži, tumor je mali, priliferativan, što je povoljna okolnost, ali postoje drugi bitniji nepovoljni činioci kao što su renalna insuficijencija, bilateralnost tumora i tumor na jedinom bubregu. Dragičević je pokazao da je broj konzervirajućih operacija značajno manji u periodu od 1998-2005. nego u ranijim periodima, obzirom da su u trenutku postavljanja dijagnoze tumori gornjeg urotelijuma sve češće višeg stepena maligniteta i stadijuma anatomskog razvoja [119].…”