Upper urinary tract transitional cell carcinoma: current treatment overview of minimally invasive approaches (original) (raw)
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Archivos Espanoles De Urologia, 2009
Resumen.-OBJETIVO: El carcinoma de células transicionales del tracto urinario superior (CCT-TUS) es una enfermedad poco común. La opción de tratamiento tradicional ha sido siempre la nefroureterectomía abierta (NUA); nosotros examinamos el rol de los nuevos métodos de tratamiento. MÉTODOS: Revisión de la literatura disponible en carcinoma de células transicionales con énfasis en tratamiento quirúrgico incluyendo las bases de dato de Pub-Med, Ovid, EMBASE y Science Direct, para artículos en ingles. RESULTADOS: Nefroureterecomia laparoscópica, ureteroscopía y tratamiento percutáneo constituyen las opciones de tratamiento disponibles con adecuados resultados de control oncológico según las características específicas de cada paciente. CONCLUSIONES: Las indicaciones de tratamiento mínimamente invasivo para CCT-TUS se están expandiendo e incluyen diferentes opciones que permiten racionalizar el tratamiento. Summary.-OBJECTIVES: Upper urinary tract transitional cell carcinoma (UUT-TCC) is a rare disease. Open nephroure-terectomy remains the gold standard for surgical treat-ment. We aim to evaluate the standing of novel surgical treatment in UUT-TCC. RESULTADOS: Laparoscopic nephroureterectomy, ureteroscopy and percutaneous treatment are the available surgical options that based on adequate patient selection offer acceptable cancer control. CONCLUSIONES: Indications for the treatment of UT-TCC are expanding and this allows clinicians to tailor treatment while preserving oncological results.
BJU International, 2007
To determine the surgical feasibility and early oncological outcomes of laparoscopic distal ureterectomy in patients with low-grade upper urinary tract transitional cell carcinoma (UUT-TCC). We retrospectively reviewed patients treated laparoscopically with conservative management for a UUT-TCC between 2001 and 2005. We collected data on gender, age, mode of diagnosis, smoking, history of bladder cancer, complications, tumour site, size, stage, grade, hospital stay, recurrence and progression. Data were analysed for six patients with a mean (range) age of 68.5 (54-76) years. Four patients had a diagnostic ureteroscopy with biopsy. The operative duration was 173.3 (120-240) min, the estimated blood loss was 75 (50-200) mL and the length of ureteric resection was 5.23 cm. Two patients required a psoas hitch. JJ stents were maintained for 25.8 (15-30) days. The hospital stay was 6 (5-8) days. There were minor complications in three patients after surgery. The follow-up was 32 (17-46) months. The tumour size was 1.7 (0.8-2.6) cm. There were low-grade tumours in four patients and pTa in five. All patients are alive and free of disease; there were no anastomotic strictures. Two patients developed a recurrence, one in the ipsilateral renal pelvis and one in the bladder. Laparoscopic distal ureterectomy with direct re-implantation is technically feasible for low-risk UUT-TCC (i.e. low-grade, noninvasive), in the properly selected patient. Early oncological outcomes are promising but strict surveillance protocols must be followed.
World Journal of Surgical Oncology, 2008
Objectives: To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC). Patients and methods: From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression. Results: The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3-72) for RNU and 27.9 months (range 3-63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227). Conclusion: Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.
Urology, 2006
Objectives. To compare the outcomes in patients who had undergone either open nephroureterectomy or conservative endoscopic surgery (ureteroscopic or percutaneous management) for upper urinary tract transitional cell carcinoma. Methods. We performed a retrospective review of the data for patients treated surgically for upper urinary tract transitional cell carcinoma from 1990 to 2004. The data included patient sex, age at diagnosis, mode of diagnosis, smoking history, history of bladder cancer, type of surgery, complications, and tumor site, size, stage, grade, recurrence, and progression. We also evaluated the recurrence and survival rates. Results. Data were analyzed for 97 patients. The median patient age was 68 years. Sixteen patients had a history of bladder tumor. The surgical procedure was open nephroureterectomy in 54 patients, ureteroscopy in 27, and percutaneous endoscopic ablation in 16. The tumor stage, grade, and site were independent prognostic factors for survival in a multivariate analysis (P Ͻ0.05). The 5-year disease-specific survival rate was 81.9% for low-grade tumors and 47.3% for high-grade tumors (P ϭ 0.0001). A correlation (P ϭ 0.002) was found between low-grade tumors and superficial tumors. In patients with low-grade tumors (n ϭ 46), the 5-year disease-specific survival rate after nephroureterectomy, ureteroscopy, and percutaneous endoscopy was 84%, 80.7%, and 80%, respectively (P ϭ 0.89); the corresponding 5-year tumor-free survival rates were 75.3%, 71.5%, and 72% (P ϭ 0.78). Conclusions. Conservative surgery can be recommended as an alternative to nephroureterectomy for lowgrade or superficial upper urinary tract transitional cell carcinoma. For patients with high-grade or invasive tumors to be candidates for conservative surgery will require the development of additional prognostic factors (eg, molecular markers). These patients require long-term postoperative surveillance.
European Urology, 2003
Introduction: Laparoscopic nephroureterectomy reduces the morbidity of surgical management of urinary tract transitional cell carcinoma (TCC), but a potentially increased risk for local tumour spreading was reported. We evaluated results obtained from patients undergoing a modified laparoscopic approach and open procedures in this respect. Patients and Methods: Between January 2000 and March 2002 we performed 19 modified laparoscopic nephroureterectomies (LNU) with open intact specimen retrieval in conjunction with open distal ureter and bladder cuff removal and 15 open standard nephroureterectomies (ONU). Staging lymphadenectomy was performed in 14/19 (73.7%) patients with LNU and in 6/15 (40.0%) with ONU.
Conservative Management of Upper Urinary Tract Tumors
European Urology, 2002
We determined the immediate and long-term results of endoscopic management of upper tract transitional cell in regard to rates of tumor recurrence and preservation of renal function. Materials and Methods: From January 1990 to July 1999, 61 patients (mean age 66.2 years) underwent endoscopic management of upper tract cell carcinoma. Of the patients 20 (32%) had a solitary kidney. Tumors were resected in a one time procedure by ureteroscopy only in 31.5%, by percutaneous nephroscopy in 29% or both in 8%; multiple treatment was necessary in 31.5% of cases using percutaneous nephroscopy only. Results: Immediate nephrectomy was done in six cases for high grade (three patients), insuf®cient local control (two cases) or patient's choices (one case). There were six cases of benign tumors excluded from survival Kaplan Meier analysis. With a mean follow-up of 39.9 months, the rate of kidney preservation, recurrence free rate, global survival and speci®c survival rates were, respectively, 81%, 68%, 77%, and 84%. Conclusions: Nephron sparing percutaneous management of upper tract cell carcinoma is applicable in a signi®cant number of patients with a ®lling defect of upper urinary tract TCC. In carefully selected patients the results are at least comparable to other forms of management of tumor control and preservation of renal function.
European Journal of Cancer, 2009
Transitional cell Renal pelvis Ureter TNM classification Lymph node metastases Cancer-specific mortality Prognosis A B S T R A C T Purpose: The TNM staging system represents the cornerstone for classifying patients with upper tract urothelial carcinoma (UTUC). We tested the prognostic impact of pT and pN stages on cancer-specific mortality (CSM) in a large population-based cohort of surgically treated patients with UTUC. Methods: Our analyses relied on 2299 patients treated with nephroureterectomy (NU) or segmental ureterectomy (SU) for UTUC within nine Surveillance, Epidemiology and End Results registries between 1988 and 2004. CSM rates after surgery were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of pT and pN stages on CSM, after adjusting for tumour grade, age, gender, primary tumour location, type and year of surgery.