Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma

Shvero, Asaf; Abu-Ghanem, Yasmin; Laufer, Menachem; Dotan, Zohar; Zilberman, Dorit E.; Mor, Yoram; Portnoy, Orith; Fridmen, Eddie; Winkler, Harry; Kleinmann, Nir

doi:10.1097/ju.0000000000001505

Cited by 21 publications

(27 citation statements)

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“…According to previous studies in UTUC, the 2-yr estimated PFS rate was approximately 70%, whereas the 2-yr estimated RFS rate ranged from 10% to 40% in cohorts including imperative/relative cases [4] , [5] , [15] . Such high recurrence rates are consistent with the findings of Villa et al [3] , who detected UTUCs in 51.2% of cases on second-look URS, and 85.7% of these were at the same lesion as the primary tumor.…”

Section: Discussionmentioning

confidence: 92%

“…A Ho:YAG laser alone or combined with Ho:YAG and Nd: YAG lasers is traditionally used for URS in UTUC [2] , [4] , [15] . The Tm:YAG laser system, which provides maximum hemostasis and coagulation with shallow penetration (0.4 mm), has been increasingly used for endoscopic treatment of UTUC since Defidio et al first reported its use in 2011 [3] , [5] , [16] , [17] , [18] .…”

Section: Discussionmentioning

confidence: 99%

“…Two possible approaches can be used: (1) precise and effective tumor ablation while controlling bleeding [2] ; or (2) accurate identification of surgical margins and residual viable tumors, which may contribute to a reduction in the recurrence rate [3] , [4] . Instead of a neodymium (Nd):yttrium aluminum garnet (YAG) laser, which is widely used for URS but not recommended for treating ureteral tumors owing to its deep penetration, a thulium (Tm):YAG laser, which has a strong hemostatic effect with shallow penetration, can be used.…”

Section: Introductionmentioning

confidence: 99%

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Photodynamic Diagnosis–guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes

Yoshida

Mizutani

Matsuzaki

et al. 2021

European Urology Open Science

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Background Although ureteroscopic surgery (URS) is beneficial for low-risk upper urinary tract carcinoma (UTUC), there is no standardized URS technique or navigation system for challenging cases. Objective To present a URS technique for UTUC using thulium (Tm):YAG and holmium (Ho):YAG lasers under photodynamic diagnosis (PDD) guidance, named PDD-guided dual laser ablation (PDD-DLA) and compare its efficacy with that of conventional Ho:YAG laser ablation (HLA; historical control). Design, setting, and participants The study included ten consecutive UTUC patients who underwent PDD-DLA between 2017 and 2019. The control group comprised 16 consecutive patients who underwent HLA between 2006 and 2016. Surgical procedure After oral administration of 5-aminolevulinic acid (20 mg/kg), UTUC tumors were endoscopically resected via PDD-DLA. Measurements Clinical data were prospectively collected for our institutional UTUC data set. Disease progression, UTUC recurrence, and clinical outcomes were assessed. Results and limitations PDD-DLA was successfully performed in all patients. The median tumor size was 23.5 mm (interquartile range [IQR] 12.8–30.0) and there were four cases (40.0%) of high-grade tumor. The median operative time was 120 min (IQR 98.5–142.5). No Clavien-Dindo grade ≥3 complications were observed. There were no differences in most clinical characteristics between the PDD-DLA and HLA groups. The 2-yr progression-free survival rate was 100% in the PDD-DLA group and 58.7% in the HLA group ( p = 0.0197), and the 2-yr recurrence-free survival rate was 57.1% and 41.3%, respectively ( p = 0.072). The PDD-DLA group had a lower incidence rate of salvage RNU compared with the HLA group (0.0% vs 50%; p = 0.009). The small sample size might affect the reproducibility of these results. Conclusions PDD-DLA seems to be an effective and feasible endoscopic technique for UTUC treatment with favorable oncological outcomes. Patient summary We investigated a new laser technique for treating cancer of the upper urinary tract called photodynamic diagnosis–guided dual laser ablation. Our strategy was effective in removing tumors and stopping bleeding. Further studies in larger groups of patients are needed to confirm whether this technique improves cancer outcomes.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Photodynamic Diagnosis–guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes

Yoshida

Mizutani

Matsuzaki

et al. 2021

European Urology Open Science

View full text Add to dashboard Cite

show abstract

“…The reason why this management approach is gaining in popularity is because of its lower morbidity and similar oncological outcomes (cancer-specific and overall survival) to those of radical nephroureterectomy (RNU) for patients with low risk and select patients with an imperative indication such as a solitary kidney or serious renal insufficiency [2] , [3] , [4] , [5] , [6] , [7] , for whom KST is the preferred approach according to the European Association of Urology (EAU) guidelines [1] . However, KST can also be offered to a subgroup of patients currently considered at high risk, such as patients with a large (>1 cm), multifocal, low-grade UTUC [5] , [8] . Most of the recent literature emphasizes that these characteristics do not represent absolute contraindications for a conservative approach, which is why we can safely proceed with a purely endoscopic treatment immediately followed by stringent follow-up [5] , [8] .…”

mentioning

confidence: 99%

“…However, KST can also be offered to a subgroup of patients currently considered at high risk, such as patients with a large (>1 cm), multifocal, low-grade UTUC [5] , [8] . Most of the recent literature emphasizes that these characteristics do not represent absolute contraindications for a conservative approach, which is why we can safely proceed with a purely endoscopic treatment immediately followed by stringent follow-up [5] , [8] . Furthermore, good short-term (median 22–52.4 mo [5] , [8] ) and long-term (median 75.12 mo [7] ) oncological outcomes without significant complications have been reported.…”

mentioning

confidence: 99%