Minimally invasive management of upper tract urothelial carcinoma

Abstract

Recently published studies that evaluated minimally invasive treatments for upper tract urothelial cancer (UTUC) were reviewed, including adjuvant topical therapy. Ureteroscopic management remains the initial diagnostic and possibly therapeutic procedure of choice. Percutaneous management is used to treat bulky tumors or tumors that cannot be accessed ureteroscopically. Low-grade UTUC in appropriately selected patients can be safely and effectively treated endoscopically. High-grade disease tends to fail, regardless of treatment modality, and warrants aggressive therapy. Adjuvant therapy seems to be safe, although its efficacy is debatable. Immunotherapy appears to be most effective in patients with upper tract carcinoma in situ.

Transitional cell carcinomas of the renal pelvis and the ureter: comparative demographic characteristics, pathological grade and stage and 5‐year survival in a Taiwanese population

“…In this study, the recurrence rate after total NU with BCE was 13%, which is lower than the reported 20–45% rate of recurrence after incomplete ureterectomy [26–28]. Tumour stage, grade, vessel invasion and age are important factors in prognosis and survival [21,22,28–32]. Recent studies evaluated minimally invasive treatments for upper tract TCC, e.g.…”

“…Recent studies evaluated minimally invasive treatments for upper tract TCC, e.g. adjuvant topical therapy [32–34]. Ureteroscopic management remains the preferred procedure for initial diagnosis and therapeutic treatment of low‐grade upper tract TCC.…”

Review of Topical Treatment of Upper Tract Urothelial Carcinoma

“…Laparoscopic surgery has broadened the population of patients who are able to tolerate this surgery; however, due to concerns for preservation of renal function or inability to tolerate surgery, a selected group of patients may be suitable candidates for less-invasive management with endoscopic approach. Organ-preserving endoscopic procedures may be appropriate for patients with a solitary kidney, bilateral disease, poor renal function, or inability to tolerate major surgery [1, 2]. In addition, the indications for minimally invasive therapy have evolved to include small tumor burden, low-grade disease, or carcinoma in situ in patients with normal contralateral renal function [3].…”