The Role of Chemotherapy in Upper Tract Urothelial Carcinoma

Locally advanced upper tract urothelial carcinoma has a poor prognosis. While surgery represents the only potentially curable therapeutic intervention, recurrences are common and typically systemic in nature. It is thus reasonable to consider perioperative chemotherapy in an effort to decrease the risk of recurrence. There are very little direct data providing clinical guidance in this scenario. For urothelial cancer of the bladder, there are randomized phase III data demonstrating a survival advantage with neoadjuvant cisplatin-based combination chemotherapy. Although arguments favoring adjuvant chemotherapy could be made for upper tract urothelial cancer, the loss of renal function that occurs with nephrectomy can complicate administration of appropriate perioperative treatment. Therefore, by analogy to urothelial carcinoma of the lower tract, it is argued that cisplatin-based neoadjuvant chemotherapy should be the standard of care for patients with locally advanced upper tract urothelial cancer.

Download Full-text

Robotic radical nephroureterectomy for upper tract urothelial carcinoma: Data from the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) collaborative group

European Urology Open Science ◽

10.1016/s2666-1683(20)32772-5 ◽

2020 ◽

Vol 19 ◽

pp. e322-e324

Author(s):

A. Veccia ◽

J. Steward ◽

I. Derweesh ◽

V. Margulis ◽

R. Uzzo ◽

...

Keyword(s):

Robotic Surgery ◽

Urothelial Carcinoma ◽

Urothelial Cancer ◽

Upper Tract Urothelial Carcinoma ◽

Collaborative Group ◽

Radical Nephroureterectomy ◽

Cancer Study ◽

Upper Tract ◽

Upper Tract Urothelial Cancer

Download Full-text

Treatment of Distal Upper Tract Urothelial Cancer with Distal Ureterectomy Preserves Renal Function without Increasing Local Recurrence Rate Compared with Radical Nephroureterectomy

Nepalese Journal of Cancer ◽

10.3126/njc.v5i1.41316 ◽

2021 ◽

Vol 5 (1) ◽

pp. 86-90

Author(s):

Mahesh Bahadur Adhikari ◽

Woon Chau Tsang ◽

Ho Yee Tiong

Keyword(s):

Renal Function ◽

Hospital Stay ◽

Urothelial Carcinoma ◽

Urothelial Cancer ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Upper Tract ◽

Duration Of Surgery ◽

Upper Tract Urothelial Cancer ◽

Distal Ureterectomy

Introduction: Kidney sparing surgery like endoscopic resection and distal ureterectomy has been recently proposed as alternative surgical options to manage distal Upper Tract Urothelial Cancer. This study aims to compare the surgical, oncological and functional outcomes of distal ureterectomy and Radical Nephroureterectomy for distal Upper Tract Urothelial Carcinoma. Methods and Material: Out of 57 patients with Upper Tract Urothelial Carcinoma treated surgically at a single institution between 2010 and 2016, nineteen patients had distal Upper Tract Urothelial Carcinoma. A retrospective review was performed on these 19 patients (11 Radical Nephroureterectomy and 8 distal ureterectomy). Radical Nephroureterectomy was performed using an open or laparoscopic approach (n= 4 and 7 respectively). All Distal Ureterectomy patients were performed via an open extra-peritoneal Gibson incision. Pelvic lymphadenectomy and Subsequent ureteroneocystostomy in the Distal Ureterectomy group was performed directly and was augmented by psoas hitch or using boari flap reconstruction. Demographic, clinical features and post-operative outcomes were compared between the Radical Nephroureterectomy and Distal Ureterectomy groups. Results: There was a trend towards shorter mean duration of surgery (238±34 vs. 286 ±90 min) and length of hospital stay (LOS) (7.6±2.8 vs. 17.3±20.7 days) in the Distal Ureterectomy group compared to the Radical Nephroureterectomy group (P=NS). Peri-operative Complication of Clavien grade 1-2 was seen in 4(33.33%) Radical Nephroureterectomy and 3 (37.5%) Distal Ureterectomy cases respectively. All patients had high grade Upper Tract Urothelial Carcinoma with equivalent pTNM staging in both groups with clear surgical margins. Immediate post-operative renal function improvement was statistically significant in the Distal Ureterectomy group (Radical Nephroureterectomy 2.27±5.93 vs 10.86±9.92 Distal Ureterectomy, p=0.034). Three out of 11 Radical Nephroureterectomy group patients required dialysis. Conclusions: Local recurrences were similar after Distal Ureterectomy and Radical Nephroureterectomy with equivalent pathological outcomes in distal Upper Tract Urothelial Carcinoma. There was a clear trend towards shorter hospital stay and better renal function preservation in favor of Distal Ureterectomy with fewer patients requiring dialysis.

Download Full-text