Third Prize: The Role of Endoscopic Nephron-Sparing Surgery in the Management of Upper Tract Urothelial Carcinoma

Abstract

NSS offered shorter hospital stay but had increased risk of recurrence. Therefore, extreme care should be made to rule out occult invasive tumors preoperatively. Patients being managed endoscopically must be informed of the necessity for close follow-up.

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

“…Recently, the previously accepted standard of radical nephroureterectomy (RNU) for all stages of upper tract UC has been questioned. Nephron-sparing surgery (NSS) has been suggested as an alternative for patients with early stages of disease [22,23]. Reasons for NSS included marked differences in 5-year survival [23] and cancer-related mortality [24] between non-invasive and invasive UC of the UUT.…”

“…Nephron-sparing surgery (NSS) has been suggested as an alternative for patients with early stages of disease [22,23]. Reasons for NSS included marked differences in 5-year survival [23] and cancer-related mortality [24] between non-invasive and invasive UC of the UUT. 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.…”

“…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. Authors suggested that extreme care should be taken to rule out occult invasive tumor prior to therapy and to follow up patients with NSS for upper tract UC closely [23]. Also, in patients with UC affecting the bladder and at least one UUT, or in panurothelial disease, therapeutic concepts try to be as radical as necessary while preserving as much urinary tract function as possible [26,27].…”

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

“…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.…”

Efficacy of instillations with chemotherapy or immunotherapy following endoscopic resection for upper tract urothelial carcinoma

“…Although the benefits of topical therapy are yet to be established, there is a strong body of evidence to support the endoscopic treatment of tumors, particularly those that are of low grade and small in size. Although recurrence rates may be higher and follow-up regimens much more strict, low-grade, low-volume disease uncommonly progresses in stage or grade and should be tackled endoscopically given the armamentarium currently at our disposal [6,31,32,[64][65][66]. Patients with high-grade disease fare poorly regardless of conservative treatment options, and nephroureterectomy should be advised [29,67,68].…”