Segmental Ureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis of Comparative Studies

Abstract

Radical nephroureterectomy (RNU) represents the standard of care for high-risk upper tract urothelial carcinoma (UTUC). In selected patients with ureteral UTUC, a conservative approach such as segmental ureterectomy (SU) can be considered. However, this therapeutic option remains controversial. The aim of this study was to perform a systematic review and meta-analysis of studies assessing the outcomes of SU versus RNU in patients with UTUC. Three search engines (Scopus, Embase, and Web of Science) were queried up to May 2019. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement) was used as a guideline for study selection. The clinical question was established as stated in the PICO (Population, Intervention, Comparator, Outcome) process. Patients in the SU group were more likely to have history of bladder cancer (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.12-3.51; P ¼ .02), but less likely to present with preoperative hydronephrosis (OR, 0.52; 95% CI: 0.31-0.88; P ¼ .02). A higher rate of ureteral tumor location was found in the SU group (OR, 7.54; 95% CI,; P < .00001). The SU group presented with a lower rate of higher (pT ! 2) stage (OR, 0.66; 95% CI, 0.53-0.82; P ¼ .0002), and high-grade tumors (OR, 0.62; 95% CI, 0.50-0.78; P < .0001). The SU group was found to have shorter 5-year relapse-free survival (OR, 0.64; 95% CI, 0.43-0.95; P ¼ .03), but higher postoperative estimated glomular filtration rate (weighted mean difference, 10.97 mL/min; 95% CI, 2.97-18.98; P ¼ .007). Selected patients might benefit from SU as a therapeutic option for UTUC. In advanced high-risk disease, RNU still remains the standard of care.

Clinical features and prognostic indicators in upper-tract urothelial carcinoma with bone metastasis

“…Surgical excision and chemotherapy were also suitable for UTUC patients with bone metastasis, which was consistent with previous mainstream treatments for patients with primary tumors ( 17 , 33 , 34 ). In advanced UTUC, radical nephroureterectomy (RNU) still remains the standard of care ( 35 ). Alberto Martini et al ( 36 ) reported that neoadjuvant chemotherapy may be an option in patients with UTUC and bone metastasis.…”

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

“…02) and consequently a higher postoperative eGFR ( + 10.97 mL/min/1.73m 2 ; 95%CI 2.97 -18.98, P = .007). 8 However, in cases with pre-operative hydronephrosis and impaired renal function no differences were found between SU and RNU in terms of post-operative eGFR. 9 In line with these results, in this study including patients older than 75 years of age with a pre-operative impaired renal function (mean pre-operative eGFR 52.6 ± 18.5 mL/min/1.73m 2 ), we did not found any significant post-operative variation of renal function in the two groups.…”

Segmental ureterectomy outcome of upper tract urothelial carcinoma in a high endemic area: A Taiwan nationwide collaborative study

“…In the NCCN guideline, low-risk or favorable criteria included papillary variant, unifocal, low-grade tumor, size <1.5 cm, and no invasive features in the cross-sectional imaging. A previous study showed that KSS for low-risk UTUCs could reduce morbidity rates, such as loss of kidney function, with oncology outcomes comparable to RNU [6][7][8] . The guidelines of EAU and NCCN recommended management as an option for low-risk and localized UTUCs.…”