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Conservative Nephron-Sparing Treatment of Upper-Tract Tumors

Abstract

While radical nephroureterectomy represents the gold standard for managing upper-tract urothelial carcinoma, nephron-sparing approaches have increasingly been utilized in the elective setting. Such considerations are accentuated by contemporary studies highlighting sequelae related to chronic kidney disease following nephrectomy. Kidney sparing treatments including segmental ureteral resection and endoscopic ablation may therefore be appropriate in select patients with small, solitary, low-grade upper-tract tumors. Bladder and ipsilateral upper-tract recurrences are frequent after nephron-sparing treatments for UTUC, thereby underscoring the need to maintain strict radiographic and endoscopic surveillance protocols in patients amenable to this rigorous compliance program.

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References

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

  1. Assimos DG, Hall MC, Martin JH. Ureteroscopic management of patients with upper tract transitional cell carcinoma. Urol Clin North Am. 2000;27(4):751–60.

    PubMed  Article  CAS  Google Scholar 

  2. Soderdahl DW, et al. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. 2005;23(2):114–22.

    PubMed  Article  Google Scholar 

  3. Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000;164(5):1523–5.

    PubMed  Article  CAS  Google Scholar 

  4. Lam JS, Gupta M. Ureteroscopic management of upper tract transitional cell carcinoma. Urol Clin North Am. 2004;31(1):115–28.

    PubMed  Article  Google Scholar 

  5. Raman JD, Scherr DS. Management of patients with upper urinary tract transitional cell carcinoma. Nat Clin Pract Urol. 2007;4(8):432–43.

    PubMed  Article  Google Scholar 

  6. Zincke H, et al. Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract. J Urol. 1976;116(6):781–3.

    PubMed  CAS  Google Scholar 

  7. Keeley FX, et al. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997;157(1):33–7.

    PubMed  Article  CAS  Google Scholar 

  8. Stewart GD, et al. A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract. BJU Int. 2005;95(6):791–3.

    PubMed  Article  Google Scholar 

  9. Ristau BT, Tomaszewski JJ, Ost MC. Upper tract urothelial carcinoma: current treatment and outcomes. Urology. 2012;79(4):749–56.

    PubMed  Article  Google Scholar 

  10. • NCCN Clinical Practice Guidelines in Oncology--Bladder Cancer. 2013; 1.2013:[Available from: www.nccn.org. Current NCCN guidelines emphasizing that segmental ureteral resection is a reasonable treatment option for patients with low grade UTUC of the middle or distal ureter.

  11. Mazeman E. Tumours of the upper urinary tract calyces, renal pelvis and ureter. Eur Urol. 1976;2(3):120–6.

    PubMed  CAS  Google Scholar 

  12. • Jeldres C, et al. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010;183(4):1324–9. Recent SEER database study highlighting that segmental ureterectomy confers equivalent oncologic outcomes as radical nephroureterectomy.

    PubMed  Article  Google Scholar 

  13. Lehmann J, et al. Transitional cell carcinoma of the ureter: prognostic factors influencing progression and survival. Eur Urol. 2007;51(5):1281–8.

    PubMed  Article  Google Scholar 

  14. Box GN, et al. Minimally invasive management of upper tract malignancies: renal cell and transitional cell carcinoma. Urol Clin North Am. 2008;35(3):365–83. vii.

    PubMed  Article  Google Scholar 

  15. Bagley DH, Grasso 3rd M. Ureteroscopic laser treatment of upper urinary tract neoplasms. World J Urol. 2010;28(2):143–9.

    PubMed  Article  Google Scholar 

  16. Chen GL, Bagley DH. Ureteroscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. J Urol. 2000;164(4):1173–6.

    PubMed  Article  CAS  Google Scholar 

  17. Daneshmand S, Quek ML, Huffman JL. Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience. Cancer. 2003;98(1):55–60.

    PubMed  Article  Google Scholar 

  18. Elliott DS, et al. Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney. Urology. 2001;58(2):174–8.

    PubMed  Article  CAS  Google Scholar 

  19. Keeley Jr FX, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. 1997;157(5):1560–5.

    PubMed  Article  Google Scholar 

  20. Martinez-Pineiro JA, Garcia Matres MJ, Martinez-Pineiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996;156(2 Pt 1):377–85.

    PubMed  Article  CAS  Google Scholar 

  21. Roupret M, et al. Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology. 2006;67(6):1181–7.

    PubMed  Article  Google Scholar 

  22. Lucas SM, et al. Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int. 2008;102(2):172–6.

    PubMed  Article  Google Scholar 

  23. Thompson RH, et al. Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. Urology. 2008;71(4):713–7.

    PubMed  Article  Google Scholar 

  24. Jabbour ME, Smith AD. Primary percutaneous approach to upper urinary tract transitional cell carcinoma. Urol Clin North Am. 2000;27(4):739–50.

    PubMed  Article  CAS  Google Scholar 

  25. Liatsikos EN, et al. Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach. J Endourol. 2001;15(4):377–83. discussion 397.

    PubMed  Article  CAS  Google Scholar 

  26. Palou J, et al. Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol. 2004;172(1):66–9.

    PubMed  Article  Google Scholar 

  27. • Rastinehad AR, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guerin therapy? Urology. 2009;73(1):27–31. Large, contemporary series highlighting the therapeutic efficacy of BCG used in an adjuvant setting following endoscopic management of UTUC.

    PubMed  Article  Google Scholar 

  28. Lee BR, et al. 13-year survival comparison of percutaneous and open nephroureterectomy approaches for management of transitional cell carcinoma of renal collecting system: equivalent outcomes. J Endourol. 1999;13(4):289–94.

    PubMed  Article  CAS  Google Scholar 

  29. Jarrett TW, et al. Percutaneous management of transitional cell carcinoma of the renal collecting system: 9-year experience. J Urol. 1995;154(5):1629–35.

    PubMed  Article  CAS  Google Scholar 

  30. Goel MC, Mahendra V, Roberts JG. Percutaneous management of renal pelvic urothelial tumors: long-term followup. J Urol. 2003;169(3):925–9. discussion 929–30.

    PubMed  Article  Google Scholar 

  31. Clark PE, Streem SB. Endourologic management of upper tract transitional cell carcinoma. Scie World J. 2004;4 Suppl 1:62–75.

    Article  Google Scholar 

  32. Rastinehad AR, Smith AD. Bacillus Calmette-Guerin for upper tract urothelial cancer: is there a role? J Endourol. 2009;23(4):563–8.

    PubMed  Article  Google Scholar 

  33. Thalmann GN, et al. Long-term experience with bacillus Calmette-Guerin therapy of upper urinary tract transitional cell carcinoma in patients not eligible for surgery. J Urol. 2002;168(4 Pt 1):1381–5.

    PubMed  Google Scholar 

  34. Keeley Jr FX, Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997;158(6):2074–7.

    PubMed  Article  CAS  Google Scholar 

  35. Bin, X., et al. Impact of tumour location and surgical approach on recurrence-free and cancer-specific survival analysis in patients with ureteric tumours. BJU Int, 2012.

  36. Giannarini G, et al. Elective management of transitional cell carcinoma of the distal ureter: can kidney-sparing surgery be advised? BJU Int. 2007;100(2):264–8.

    PubMed  Article  Google Scholar 

  37. Leitenberger A, Beyer A, Altwein JE. Organ-sparing treatment for ureteral carcinoma? Eur Urol. 1996;29(3):272–8.

    PubMed  CAS  Google Scholar 

  38. Zincke H, Neves RJ. Feasibility of conservative surgery for transitional cell cancer of the upper urinary tract. Urol Clin North Am. 1984;11(4):717–24.

    PubMed  CAS  Google Scholar 

  39. Raymundo EM, et al. Third prize: the role of endoscopic nephron-sparing surgery in the management of upper tract urothelial carcinoma. J Endourol. 2011;25(3):377–84.

    PubMed  Article  Google Scholar 

  40. Cornu JN, et al. Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol. 2010;28(2):151–6.

    PubMed  Article  Google Scholar 

  41. Pak RW, Moskowitz EJ, Bagley DH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol. 2009;23(3):341–6.

    PubMed  Article  Google Scholar 

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Correspondence to Jay D. Raman.

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Smith, P., Mandel, J. & Raman, J.D. Conservative Nephron-Sparing Treatment of Upper-Tract Tumors. Curr Urol Rep 14, 102–108 (2013). https://doi.org/10.1007/s11934-013-0305-1

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  • DOI: https://doi.org/10.1007/s11934-013-0305-1

Keywords

  • Endoscopy
  • Ureteroscopy
  • Percutaneous
  • Segmental ureteral resection
  • Topical therapy