Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long‐term follow‐up in a series of 73 patients

Abstract

Study Type – Therapy (outcome) Level of Evidence 2b What's known on the subject? and What does the study add? Upper Urinary Tract (UUT) Transitional Cell Carcinoma (TCC) is an uncommon disease and represents approximately 5% of all urothelial carcinomas. We report our series on 73 patients treated with Kidney Sparing Surgery for UUT TCC. Good results have been achieved in terms of oncological outcome comparing this conservative approach to the radical nephrourectomy. OBJECTIVES To report the long‐term oncological outcome in patients with transitional cell carcinoma of the ureter electively treated with kidney‐sparing surgery. To compare our data with the few series reported in the literature. PATIENTS AND METHODS We considered 73 patients with transitional cell carcinoma of the distal ureter treated in five Italian Departments of Urology. The following surgeries were carried out: 38 reimplantations on psoas hitch bladder (52%), 21 end‐to‐end anastomoses (28.8%), 11 direct ureterocystoneostomies (15.1%) and three reimplantations on Boari flap bladder (4.1%). The median follow‐up was 87 months. RESULTS Tumours were pTa in 42.5% of patients, pT1 in 31.5%, pT2 in 17.8% and pT3 in 8.2%. Recurrence of bladder urothelial carcinoma was found in 10 patients (13.7%) after a median time of 28 months. The bladder recurrence‐free survival at 5 years was 82.2%. The overall survival at 5 years was 85.3% and the cancer‐specific survival rate at 5 years was 94.1%. CONCLUSION Our data show that segmental ureterectomy procedures do not result in worse cancer control compared with data in the literature regarding nephroureterectomy.

Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter: A propensity score‐matched multicenter study

“…12 Simonato et al reported that 5-year CSS rates were 94.1% in 73 patients with distal ureteral tumors treated with DUx. 13 Recently, Dalpiaz et al showed that CSS was 77% for 49 patients treated with DUx, which was comparable with those for patients treated with NUx. 7 However, patient and tumor characteristics of DUx could be intrinsically different from patients with NUx.…”

“…Simonato et al . reported that 5‐year CSS rates were 94.1% in 73 patients with distal ureteral tumors treated with DUx . Recently, Dalpiaz et al .…”

“…[1][2][3][4][5][6][7][8][9] According to the EAU and NCCN guidelines, segmental resection of the distal ureter could be an option even in patients with high-grade locally-invasive distal ureteral UC. 10,11 However, there have been just three retrospective studies to date that have reported an oncological outcome of DUx in patients with distal ureteral tumors, 7,12,13 and the feasibility of DUx on oncological outcomes remains unknown. Also, little data exist on whether DUx contributes to good preservation of postoperative renal function, which could lead to increased tolerance of adjuvant cisplatin-based chemotherapy.…”

Open Distal Ureterectomy and Boari Flap Reconstruction for Distal Ureteric Transitional Cell Carcinoma

“…Regarding oncological outcomes after conservative treatments we note that there is evidence that distal ureterectomy is as effective and safe as radical nephroureterectomy in terms of cancer specific survival, recurrence free survival and metastasis free survival [34]. Other studies showed no difference in overall survival, cancer specific survival and intravesical recurrence free survival [35][36][37]. Neither is there any significant deterioration in renal function post operatively similar to a multi-institutional study comparing radical and conservative surgeries [38].…”

Total ureterectomy and ileal ureteric replacement for TCC ureter in a solitary kidney

“…Oncologically however, it is evident from studies that segmental or total ureterectomy is not inferior to radical nephroureterectomy. 1 …”