Endoscopic Versus Laparoscopic Management of Noninvasive Upper Tract Urothelial Carcinoma: 20-Year Single Center Experience

Cutress, Mark L.; Stewart, Grant D.; Tudor, Edward; Egong, Eric A.; Wells-Cole, Simon; Phipps, Simon; Thomas, Ben; Riddick, Antony C. P.; McNeill, S. Alan; Tolley, David A.

doi:10.1016/j.juro.2012.12.006

Cited by 70 publications

(44 citation statements)

References 28 publications

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“…Tumor grade was another impact factor of oncologic outcome. Cutress et al (Cutress et al, 2013) found that compared with nephroureterectomy, kidney preservation treatment had significantly lower survival rate of IRFS, PFS, CSS and OS in G2 and G3 but equivalent in G1. On the other hand, grade 2 and grade 3 upper tract urothelial carcinoma was significantly poor compared with grade 1 (Grasso et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Literature Filtration and Quality Assessmentmentioning

confidence: 99%

“…Renal function preservation is becoming recognized and kidney-sparing procedures are reserved for selected patients with lowgrade UTUC in EAU guidelines . Kidney-sparing management (KS) has been reported with durable prognostic outcomes as nephroureterectomy in several studies (Gadzinski et al, 2010;Jeldres et al, 2010;Cutress et al, 2013;Fukushima et al, 2014). Kidney preservation treatments mainly comprise segmental ureterectomy and endoscopic resection or ablation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Luo¹,

She²,

Xiong³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 99%

Section: Literature Filtration and Quality Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Luo¹,

She²,

Xiong³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…Furthermore, retrospective analysis suggests that patients with low-grade and low-stage disease benefit from a nephron-sparing surgery with similar outcomes at five years to those achieved with RNU. 6 The aim of this study is to assess the long-term oncological results in terms of recurrence, specific survival, and global survival, as well as the preservation of the renal unit in the conservative treatment of UUTC. …”

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confidence: 99%

Conservative treatment of upper urinary tract carcinoma: Long-term results

Andrada

García

Fúnez

et al. 2017

CUAJ

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Introduction: We sought to assess the long-term results of conservative treatment for upper urinary tract carcinoma (UUTC) with regard to tumour recurrence and preservation of renal unit. Methods: From October 1987 to January 2014, 65 patients (median age 68 years) were diagnosed with UUTC and underwent endoscopic and open surgical techniques. Thirteen patients had bilateral disease and one had a single kidney. The primary approach was endoscopic in 37 reno-ureteral units (20 percutaneous resections, 17 ureteroscopies ). Open surgery was performed in 19 cases. A total of 20 patients received mitomycin C. Results: Superficial stage pTa or T1 was noted in 37 patients, infiltrating stage pT2 and pT3 in seven and inverted papilloma in one. The stage of the tumour was impossible to classify in 20. With a median followup of 75.12 months (interquartile range [IQR] 144.71-17.41), the kidney preservation, recurrence, specific survival, and global survival rates were 78.5% (51/65), 40.0% (26/65), 92.3% (60/65), and 69.2% (45/65), respectively. From the patients who had recurrence, 15 were salvaged with radical nephroureterectomy (RNU). The bladder tumour recurrence rate after the surgery was 30.76% (20/65). At the end of the followup, five patients had died of UUTC progression and 16 from other causes. Postoperative complications included one case of fistula, one case of stricture, and one case of nephrectomy due to bleeding. Conclusions: In selected cases, conservative management is a safe and feasible alternative to RNU, with the advantage of renal unit preservation. IntroductionUpper urinary tract carcinoma (UUTC) is uncommon and accounts for 5-10% of all urothelial carcinomas.1,2 Radical nephroureterectomy (RNU) with excision of the bladder cuff is the gold standard treatment for localized disease, regardless of the location of the tumour in the upper urinary tract.An interest in the conservative surgery, including endoscopic ablation and segmental resection, has emerged in recent years as an alternative for patients with UUTC and renal insufficiency, solitary functional kidney, comorbidities, or bilateral tumour, accounting for approximately 2-5% of UUTC patients. 3The elective cases for nephron-sparing surgery are considered in patients with low-grade, low-stage, unifocal, small tumours. In addition, the patient has to accept close followup because of the risk of recurrence, which is the main disadvantage of this treatment. 4 After RNU, the presence of a solitary kidney can lead to a renal insufficiency stage, which is associated with an increase in cardiovascular events and, therefore, in overall mortality. 4 It is well-documented that glomerular filtration rate decreases after RNU, with a mean of 24%, according to the outcomes of a recent multicentre analysis by Kaag et al. 5 These changes in renal function may affect eligibility for adjuvant cisplatin based-therapy. 5 Moreover, multifocal recurrence of UUTC in the contralateral side has renewed the interest in conservative treatment in elective cases. F...

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“…5,7 Inaccurate diagnosis from ureteroscopic biopsy can negatively affect patient prognosis and prevent optimal clinical management. 9 Several optical imaging technologies have been proposed to improve the diagnosis of UTUC, with the goal to better stratify patients for renal-sparing management options and long-term endoscopic surveillance. Feasibility studies have been reported using narrow band imaging, 10 photodynamic diagnosis, 11 and optical coherence tomography.…”

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confidence: 99%

A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma

Bui

Mach

Zlatev

et al. 2015

Journal of Endourology

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Purpose: Tissue diagnosis of upper tract urothelial carcinoma (UTUC) is limited by variance in tumor sampling by standard ureteroscopic biopsy. Optical imaging technologies can potentially improve UTUC diagnosis, surveillance, and endoscopic treatment. We previously demonstrated in vivo optical biopsy of urothelial carcinoma of the bladder using confocal laser endomicroscopy (CLE). In this study, we evaluated a new 0.85-mm imaging probe in the upper urinary tract and demonstrated feasibility and compatibility with standard ureteroscopes to achieve in vivo optical biopsy of UTUC. Materials and Methods: Fourteen patients scheduled for ureteroscopy of suspected upper tract lesions or surveillance of UTUC were recruited. After intravenous (IV) administration of fluorescein, CLE was performed using a 0.85-mm-diameter imaging probe inserted through the working channel of standard ureteroscopes. Acquired confocal video sequences were reviewed and analyzed. A mosaicing algorithm was used to compile a series of images into a single larger composite image. Processed CLE images were compared with standard histopathologic analysis. Results: Optical biopsy of the UTUC using CLE was effectively achieved during standard ureteroscopy. There were no adverse events related to IV fluorescein administration or image acquisition. Confocal imaging of UTUC showed characteristic features similar to urothelial carcinoma of the bladder, including papillary structure, fibrovascular stalks, and pleomorphism. Lamina propria in normal areas of the renal pelvis and ureter was also identified. Conclusions: We report an initial feasibility of CLE of UTUC. Pending further clinical investigation, CLE may become a useful adjunct to ureteroscopic biopsy, endoscopic ablation, and surveillance of UTUC.

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Endoscopic Versus Laparoscopic Management of Noninvasive Upper Tract Urothelial Carcinoma: 20-Year Single Center Experience

Cited by 70 publications

References 28 publications

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

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

Conservative treatment of upper urinary tract carcinoma: Long-term results

A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma

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