Potential role of photodynamic techniques combined with new generation flexible ureterorenoscopes and molecular markers for the management of urothelial carcinoma of the upper urinary tract: adapting new technologies for the diagnosis and management of up

Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.

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26: Role of Adjuvant Radiotherapy in the Management of Urothelial Carcinoma of Upper Urinary Tract –– A Systematic Review

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)08904-0 ◽

2021 ◽

Vol 163 ◽

pp. S14

Author(s):

Osbert Zalay ◽

Michael Yan ◽

Aamer Mahmud

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Urothelial Carcinoma ◽

Adjuvant Radiotherapy ◽

Upper Urinary Tract

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Comprehensive Management of Upper Tract Urothelial Carcinoma

Advances in Urology ◽

10.1155/2009/656521 ◽

2009 ◽

Vol 2009 ◽

pp. 1-14 ◽

Cited By ~ 8

Author(s):

Georgios Koukourakis ◽

Georgios Zacharias ◽

Michael Koukourakis ◽

Kiriaki Pistevou-Gobaki ◽

Christos Papaloukas ◽

...

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

The United States ◽

Upper Urinary Tract ◽

Endoscopic Management ◽

Ureteral Orifice ◽

Cancer Specific Survival ◽

Distal Ureter ◽

Upper Tract

Urothelial carcinoma of the upper urinary tract represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75% with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.

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