Segmental ureterectomy does not compromise the oncologic outcome compared with nephroureterectomy for pure ureter cancer

Abstract

PurposePure ureter cancers are rare and account for only 1–3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma.MethodsFrom July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence.ResultsThe mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively).ConclusionThe study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.

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

“…As renal dysfunction caused by radical nephrectomy could be associated with increased risk of overall mortality including cardiovascular events and death, partial nephrectomy is recommended as the standard treatment to preserve renal function for patients with renal cell carcinoma . Similarly, kidney‐sparing surgery could provide clinical benefits for patients with UUT‐UC …”

“…20 Similarly, kidney-sparing surgery could provide clinical benefits for patients with UUT-UC. [1][2][3][4][5][6][7][8][9] Patients with distal ureteral UC can be considered as good candidates for this kidney-sparing treatment strategy, because tumors of the distal ureter would be more frequently unifocal and associated with lower recurrence rates within the upper urinary tract compared with those of the renal pelvis, mid-ureter and proximal ureter. [21][22][23] Indeed, EAU and NCCN guidelines indicate that DUx would be a treatment option for distal ureteral UC.…”

“…NUx is the gold standard for the treatment of UUT‐UC. However, kidney‐sparing surgery, including segmental or endoscopic resection, could be considered to treat patients with UUT‐UC for improved postoperative renal function preservation . 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 .…”

“…However, kidney-sparing surgery, including segmental or endoscopic resection, could be considered to treat patients with UUT-UC for improved postoperative renal function preservation. [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.…”

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.…”