Minimally invasive approach in the management of upper- urinary-tract tumours

Adamis, Stefanos; Varkarakis, John

doi:10.3109/00365599.2011.590999

Cited by 14 publications

(16 citation statements)

References 57 publications

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“…High-grade (grade 3) disease recurs at higher rates independent of therapeutic modality: percutaneous 31%, open 25%; low-grade (grade 1-2): percutaneous 6%, open 14%. For disease-specific survival there was no difference observed between stages in patients treated percutaneously vs. open, suggesting equivalent outcomes between percutaneous and open techniques [40].…”

Section: Percutaneous Managementmentioning

confidence: 89%

“…Additionally, due to the rarity of UTUC and lack of RCTs assessing efficacy of local chemotherapy, there is a lack of evidence supporting its use. The medium term results are similar to those for the treatment of bladder tumors, but have not been confirmed in long-term studies [9,40,46]. For this reason, there are no current guidelines providing a graded recommendation on the use of adjuvant local chemotherapy in the management of UTUC [39].…”

Section: Adjuvant Topical Agentsmentioning

confidence: 93%

“…Percutaneous access, as recommended by Adamis et al, is preferred for large tumors (> 1.5 cm) located proximally in renal pelvis and/or upper ureter and for ureteric recurrences after a cystectomy for bladder cancer [40]. Advantages to the percutaneous technique include treatment of larger tumor volumes, access to any site in the collecting system, improved visualization, and faster resection with deeper biopsies.…”

Section: Percutaneous Managementmentioning

confidence: 99%

“…Percutaneous management may employ various modalities for tumor ablation, including monopolar or bipolar cautery, laser, rollerball electrode, and electrovaporization. Recurrence rates are 18-28% for low-grade tumors and approximately 50% for highgrade tumors [40].…”

Section: Percutaneous Managementmentioning

confidence: 99%

“…It is not advised in elective situations if pathologic analysis and tumor grade cannot be obtained [40]. High-grade (grade 3) disease recurs at higher rates independent of therapeutic modality: percutaneous 31%, open 25%; low-grade (grade 1-2): percutaneous 6%, open 14%.…”

Section: Percutaneous Managementmentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Percutaneous Managementmentioning

confidence: 89%