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Endoscopic Treatment of Upper Tract Urothelial Carcinoma

  • Minimally Invasive Surgery (T Guzzo, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This study aims to make the reader be aware of recent trends regarding the endoscopic management of upper tract urothelial carcinoma (UTUC) via review of the urologic literature over the past 5 years. Given the rare incidence of this disease, and the lack of level 1 evidence, systematic reviews and meta-analyses were also evaluated. Studies of importance are also considered and outlined in the annotated reference section.

Recent Findings

The PubMed database was queried using the following medical subject headings (MeSH terms): “carcinoma, transitional cell,” “ureter,” “ureteral neoplasms,” “kidney pelvis,” “endoscopy,” “laser therapy,” “ureteroscopy,” “urologic surgical procedures,” and “ureteroscopes.” MeSH terms were linked together in varying combinations and limited to human studies in English. Given the relatively rare nature of upper tract urothelial carcinoma (UTUC), level 1 evidence regarding the efficacy of endoscopic treatment does not exist, even after 30+ years of experience. Rather, the literature available mostly is in the form of single institutional retrospective series consisting of relatively small numbers of patients with short to intermediate follow-up. Only within the last 3 years have published series with larger numbers of patients and mean follow-up over 5 years been made available. Even with these more robust experiences, comparisons among series are difficult given variable treatment and follow-up approaches.

Summary

Most endoscopically managed UTUC will locally recur, especially with longer follow-up. Renal preservation rate is high, however, approaching 80% with follow-up well over 3 years. Patients with high-grade disease often fare poorly regardless of treatment modality. As such, endoscopic management for high-grade urothelial carcinoma should only be used in exceptional circumstances (i.e., in those patients medically unfit for NU or those with solitary kidneys wishing to avoid the morbidity of dialysis). No level 1 evidence exists for the routine use of intraluminal adjuvant therapy for UTUC (i.e., BCG and Mitomycin C) and multiple retrospective observational series claim there is no overt benefit. The recent formation of multiple international groups with interest in UTUC may eventually lead to the production of level 1 studies regarding optimal treatment; however, uniformity in treatment approach will likely still offer challenges.

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Abbreviations

UTUC:

Upper tract urothelial carcinoma

NU:

Nephroureterectomy

UC:

Urothelial carcinoma

PNRT:

Percutaneous nephroscopic resection of tumor

URS:

Ureteroscopy

Ho:YAG:

Holmium:yttrium-aluminum-garnet

Nd:YAG:

Neodymium:yttrium-aluminum-garnet

HG:

High-grade

LG:

Low-grade

RCC:

Renal cell carcinoma

DU:

Distal ureterectomy

RR:

Relative risk

SU:

Segmental ureterectomy

NSS:

Nephron-sparing surgery

AC:

Adjuvant chemotherapy

NC:

Neoadjuvant chemotherapy

OS:

Overall survival

DSS:

Disease-specific survival

DFS:

Disease-free survival

RPG:

Retrograde pyelography

UAS:

Ureteral access sheath

*:

While NU and distal ureterectomy (DU) may be performed robotically or laparoscopically, the endoscopic management of UTUC will be taken to mean management of UTUC via ureteroscopy (URS) and/or percutaneous nephroscopic resection of tumor (PNRT) throughout this review.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA

    Daniel P. Verges, Costas D. Lallas, Scott G. Hubosky & Demetrius H. Bagley Jr.

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  1. Daniel P. Verges
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  2. Costas D. Lallas
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  3. Scott G. Hubosky
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  4. Demetrius H. Bagley Jr.
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Correspondence to Costas D. Lallas.

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Daniel P. Verges, Costas D. Lallas, and Scott G. Hubosky each declare no potential conflicts of interest.

Demetrius H. Bagley Jr. reports royalties from CR Bard, Cook, Olympus/ACMI.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Minimally Invasive Surgery

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Verges, D.P., Lallas, C.D., Hubosky, S.G. et al. Endoscopic Treatment of Upper Tract Urothelial Carcinoma. Curr Urol Rep 18, 31 (2017). https://doi.org/10.1007/s11934-017-0675-x

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