Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma

Abstract

Current guidelines recommend endoscopic management (EM) for patients with low‐risk upper urinary tract urothelial carcinoma, as well as those with an imperative indication. However, regardless of the tumor risk, radical nephroureterectomy is still mainly performed worldwide despite the benefits of EM, such as renal function maintenance, no hemodialysis requirement, and treatment cost reduction. This might be explained by the association of EM with a high risk of local recurrence and progression. Furthermore, the need for rigorous patient selection and close surveillance following EM may be relevant. Nevertheless, recent developments in diagnostic modalities, pathological evaluation, surgical devices and techniques, and intracavitary regimens have been reported, which may contribute to improved risk stratification and treatments with superior oncological outcomes. In this review, considering recent advances in endourology and oncology, we propose novel treatment strategies for optimal EM.

Editorial Comment to Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma

“…Although a higher rate of upper urinary tract recurrence is a drawback of EM and rigorous surveillance or repeated intervention may be necessary, the crucial information is that EM and nephroureterectomy have similar oncological outcomes in terms of cancer-specific survival and overall survival, especially cases with low-risk tumors. 1 A nephronsparing approach with good cancer control would lead to overall patient benefits, considering the longer life expectancy with better renal function. 5 Yusuke Goto MD, PhD Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan yusukegoto@chiba-u.jp DOI: 10.1111/iju.15223…”

“…Yoshida et al. reviewed recent studies regarding endoscopic management (EM) of UTUC, 1 focusing mainly on current clinical issues including diagnostic procedures, surgical procedures, and follow‐up after surgery. They found that accurate patient selection, surgical procedures, and perioperative management are vital for improving the oncological outcomes of EM.…”

Efficacy of cytoreductive surgery for metastatic upper tract urothelial carcinoma: a Surveillance, Epidemiology and End Results (SEER) study of 508 patients

“…Indeed, there is very little evidence available or even data related to cytoreductive surgery for mUTUC. A recent study by Yoshida et al suggested cytoreductive surgery outcomes improve when supplemented with chemotherapy although this was only preliminary research that requires further investigation ( 9 ).…”