Long-Term Outcomes of Nephroureterectomy Versus Endoscopic Management for Upper Tract Urothelial Carcinoma

Gadzinski, Adam J.; Roberts, William W.; Faerber, Gary J.; Wolf, J. Stuart

doi:10.1016/j.juro.2010.02.005

Cited by 127 publications

(91 citation statements)

References 18 publications

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“…Among 34 renal units managed endoscopically for low-grade UC of the UUT, cancer-specific and metastasis-free 5-year survival rates were 100% and 94%, respectively. However, 84% of patients had at least one ipsilateral recurrence [25]. A comparative review of outcomes in 131 patients with UC of the UUT demonstrated a recurrence risk three times as high for NSS than for RNU.…”

Section: Discussionmentioning

confidence: 99%

Catheter-based intraluminal optical coherence tomography of the normal human upper urinary tract in vivo: proof of concept and comparison with an ex-vivo porcine model

Mueller‐Lisse¹,

Bader

Englram³

et al. 2016

Bladder

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OBJECTIVE: Single-slice, cross-sectional, intraluminal optical-coherence-tomography (OCT) is a new destruction-free optical imaging method that could be applied clinically to examine the upper urinary tract from within. In-vivo access to the human upper urinary tract (UUT) was attempted. Similar performance statistics as in ex-vivo porcine UUT were expected for delineation of different wall layers by in-vivo OCT of human UUTs. MATERIALS AND METHODS:Institutional ethics committee approved OCT in a volunteer sample of 15 patients suspected of having UUT pathology (urolithiasis, strictures, urothelial carcinoma (UC)). Commercially available, catheter-mounted 400-μm-OCT-probes (lateral resolution, < 20 µm) were introduced through a rigid cystoscope and urinary catheter or a rigid ureteroscope. Delineations of different UUT wall layers were recorded for quadrants of OCT images. Continuity-corrected-chi-square-statistics were considered to be significant for P < 0.05. RESULTS:OCT was technically successful in all patients. Among quadrants of OCT images of normal UUT in vivo (n = 532) and ex vivo (n = 248), respectively, two observers in consensus found that any tissue layers delineated in 454 (85%) and 223 (90%, P = 0.089), urothelium-lamina propria in 362 (68%) and 193 (78%, P = 0.006), lamina propria-muscle layer in 445 (84%) and 200 (81%, P = 0.352), different muscle layers in 191 (36%) and 207 (84%, P < 0.001), and different urothelial cell layers in 17 (3%) and 172 (69%, P < 0.001). Histopathology-confirmed non-invasive superficial UC showed intraluminal, papillary urothelial protrusions with undistorted lamina propria in three patients. CONCLUSIONS:In-vivo OCT is technically feasible in the human UUT and may demonstrate urothelium, lamina propria, and muscle layer, and recognize non-invasive UC.

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Section: Discussionmentioning

confidence: 99%

Catheter-based intraluminal optical coherence tomography of the normal human upper urinary tract in vivo: proof of concept and comparison with an ex-vivo porcine model

Mueller‐Lisse¹,

Bader

Englram³

et al. 2016

Bladder

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“…Due to modern day advances and earlier diagnosis of lower stage tumors, laparoscopic surgery has supplanted traditional open surgical techniques, and endoscopic or segmental surgical options have taken on a greater role in management. More conservative, less invasive approaches in the management of UTUC have shown promise due to their improved perioperative morbidity, cosmesis, and earlier convalescence [14]. Despite these advantages, the efficacy and oncological safety of these laparoscopic and endoscopic procedures is a source of concern with the lack of long-term follow-up data available [15].…”

Section: Historical Perspectivementioning

confidence: 99%

“…There exists a significant risk of under staging and undertreatment in conservatively managed upper urinary tract tumors [14]. In addition to the need for improved diagnostic modalities, further investigation into treatment options must be performed.…”

Section: Conclusion and Future Outlookmentioning

confidence: 99%

Contemporary Management and Trends in the Treatment of Upper Tract Urothelial Carcinoma

Abbott

Cicic

DiMatteo

et al. 2015

World J Nephrol Urol

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Upper tract urothelial carcinoma (UTUC) represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75%, with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers. However, endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. A critical review of the current literature and various guidelines regarding tumor management in UTUC was undertaken, with a focus on surgical options. Topics reviewed include percutaneous and endoscopic approaches, laparoscopic nephroureterectomy (LNU), options regarding the management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in the treatment of UTUC. Both National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) current guidelines are reviewed. Limited recommendations are provided by the American Urological Association (AUA). Scant level 1 or grade A evidence was noted in the establishment of the various guidelines. There is debate regarding how to best manage UTUC. With the current trend towards minimally invasive, localized, and precise surgical treatments for all solid malignancies, we must evaluate this movement as it applies to UTUC. Nephron sparing surgery is the preferred option, when feasible, in the management of other renal malignancies. This, too, must be considered when managing UTUC. Higher quality research is needed to better establish evidence-based guidelines. However, this is a challenging prospect given the low incidence of UTUC and the difficulties encountered in creating appropriate protocols.

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“…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.…”

Section: Literature Filtration and Quality Assessmentmentioning

confidence: 99%

“…Renal function preservation is becoming recognized and kidney-sparing procedures are reserved for selected patients with lowgrade UTUC in EAU guidelines . Kidney-sparing management (KS) has been reported with durable prognostic outcomes as nephroureterectomy in several studies (Gadzinski et al, 2010;Jeldres et al, 2010;Cutress et al, 2013;Fukushima et al, 2014). Kidney preservation treatments mainly comprise segmental ureterectomy and endoscopic resection or ablation.…”

Section: Introductionmentioning

confidence: 99%

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

Luo¹,

She²,

Xiong³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Long-Term Outcomes of Nephroureterectomy Versus Endoscopic Management for Upper Tract Urothelial Carcinoma

Cited by 127 publications

References 18 publications

Catheter-based intraluminal optical coherence tomography of the normal human upper urinary tract in vivo: proof of concept and comparison with an ex-vivo porcine model

Catheter-based intraluminal optical coherence tomography of the normal human upper urinary tract in vivo: proof of concept and comparison with an ex-vivo porcine model

Contemporary Management and Trends in the Treatment of Upper Tract Urothelial Carcinoma

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

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