Primary Percutaneous Approach to Upper Urinary Tract Transitional Cell Carcinoma (original) (raw)
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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.
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.
… urology and nephrology, 2006
Purpose: In this study we tried to evaluate the predictive factors for survival in patients with upper urinary tract tumors. Materials and methods: From 1993 to 2003, 46 patients were treated by standard nephroureterectomy for upper urinary tract tumor, but only 24 patients (52%) who had regular follow-up were included in the study. Age, sex, presenting symptoms of the patients, tumor localization, tumor stage and grade were analyzed with respect to survival. Univariate and multivariate analyses were done using Kaplan-Meier method with log-rank test and Cox proportional hazards regression model, respectively. Results: The median of patient age was 61 years (34-74). Of the 24 patients, 9 (37.5%) were disease-free and alive at a mean time of 54 (26-97) months, 8 (33.3%) died of disease at a mean period of 23.4 months (2 because of bladder tumor, 2 had liver metastases, 1 had lung metastasis and 3 had lung and liver metastases) and 7 (29.2%) died disease-free at a mean period of 30.3 months. Metastases were detected in a mean period of 11.8 (6-24) months. Survival according to tumor stage Ta, T1-2, and invasive tumors were 87.5, 43.9, 15.7 months (p=0.0001), respectively. Survival of the patients with low-grade tumors was significantly longer than those with high-grade tumors (77.3 and 31.4 months, respectively, p=0.01). Patients with pelvis tumors when compared to ureter tumors (28.5 and 61.6 months, respectively, p=0.038) and those presenting with flank pain when compared to those presenting with macroscopic hematuria and bladder cancer (17.7, 45.7, and 57.9 months, respectively, p=0.046) had shorter survival rates. When multivariate analyses were done using Cox regression test, the only factor that affected survival was the stage of the tumor. Age and gender had no impact on survival. Conclusions: In univariate analysis, the stage, grade, localization of the tumor and presenting symptoms were found important predictors that affect the prognosis of the transitional carcinoma of the upper tract. However, tumor stage was the only independent predictor of survival in multivariate analysis. For high grade and high stage tumors, really effective adjuvant treatments along with aggressive surgery may be considered.
Cancer, 1976
A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.
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, 2001
To evaluate the endoscopic management of upper urinary tract transitional cell carcinoma (TCC) as a first-line treatment in patients with a normal contralateral kidney. During an 11-year period, 21 patients diagnosed with upper tract TCC were treated with conservative endourologic techniques using either neodymium:yttrium-aluminum-garnet laser or electrocautery at our institution. The 21 patients were followed up for a mean of 6.1 years (range 1 to 11.6). A total of 8 renal pelvic tumors and 13 ureteral tumors were found. All tumors were Stage T1 or less and grade 3 or less. All tumors were less than 2 cm in the greatest dimension (range 0.4 to 2). Of the 21 patients, 7 (33%) had one local recurrence and 1 (4.7%) developed two local recurrences. Of the 13 ureteral tumors, 6 (46%) recurred; 1 (12%) of the 8 renal pelvic tumors recurred. No recurrent tumor was shown to have an increase in grade. Of the 21 target renal units, 17 (81%) were preserved; 4 (19%) of 21 patients required nephroureterectomy because of tumor recurrence. Overall, 11 patients in the series died, 10 of non-TCC etiology and 1 secondary to invasive bladder TCC that developed after treatment for upper tract TCC. No patients died as a result of conservative management of their upper tract TCC. Endourologic techniques and conservative treatment of upper tract TCC is an evolving field; however, in properly selected patients, endoscopic treatment can be safely and effectively used as a first-line treatment for upper tract TCC.
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
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.