Segmental Ureterectomy Versus Radical Nephroureterectomy in Older Patients Treated for Upper Tract Urothelial Carcinoma

Abrate, Alberto; Sessa, Francesco; Sessa, Maurizio; Campi, Riccardo; Sebastianelli, Arcangelo; Varca, Virginia; Pavone, Carlo; Vella, Marco; Bartoletti, Riccardo; Ficarra, Vincenzo; Serni, Sergio; Brunocilla, Eugenio; Gregori, Andrea; Trombetta, Carlo; Lissiani, A.; Terrone, Carlo; Schiavina, Riccardo; Gacci, Mauro; Simonato, Alchiede

doi:10.1016/j.clgc.2022.01.007

Cited by 6 publications

(1 citation statement)

References 16 publications

(14 reference statements)

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“…SU was shown to have acceptable oncological results re garding local, metastatic, and bladder recurrence, similar to those of RNU [34]. A study of 3,061 patients with UTUC from The National Cancer Database showed SU as a valid surgical method that did not meaningfully sacrifice oncologic control in appropriately selected patients with UTUC [35].…”

Section: Segmental Ureterectomymentioning

confidence: 99%

Nephron-Sparing Surgery for Upper Urinary Tract Urothelial Carcinoma

Kim,

Savul,

Lerner

2024

J Urol Oncol

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Radical nephroureterectomy (RNU) remains the gold standard for the surgical management of upper tract urothelial carcinoma (UTUC) from the ureterovesical junction to the renal pelvis. However, the removal of the ipsilateral intact kidney causes morbidity due to renal functional deterioration after RNU. Recently, the indications for nephron-sparing surgery (NSS) in UTUC have been expanded to preserve the intact kidney. Minimally invasive surgical approaches, including endourological, laparoscopic, and robotic-assisted techniques for segmental resection of the distal ureter with ureteral reimplantation have shown favorable oncological and clinical outcomes (for both noninvasive and invasive ureteral tumors). The established guidelines for UTUC have limited indications for NSS. Because of low tumor burden, stage Ta/T1 UTUC is considered the best indication for NSS. NSS requires close follow-up and managing the risk of recurrence in the preserved ipsilateral ureter and/or renal pelvis. To overcome these limitations, adjuvant administration of various immuno-chemotherapeutic agents is being explored to overcome the resistance to therapeutic cell death and evasion of immune destruction from current therapies with better prognostic outcomes. The aim is to reduce urothelial cancer recurrence improving the effectiveness of NSS and to achieve comparable outcomes to RNU in UTUC. In this review article, we have comprehensively discussed the different types of NSS in UTUC, the indications for NSS in the international guidelines, and oncological outcomes of each of the NSS techniques.

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Section: Segmental Ureterectomymentioning

confidence: 99%