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• W2113509715 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2013Endoscopic Versus Laparoscopic Management of Noninvasive Upper Tract Urothelial Carcinoma: 20-Year Single Center Experience Mark L. Cutress, Grant D. Stewart, Edward C.G. Tudor, Eric A. Egong, Simon Wells-Cole, Simon Phipps, Ben G. Thomas, Antony C.P. Riddick, S. Alan McNeill, and David A. Tolley Mark L. CutressMark L. Cutress Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author , Grant D. StewartGrant D. Stewart Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author , Edward C.G. TudorEdward C.G. Tudor Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author , Eric A. EgongEric A. Egong Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author , Simon Wells-ColeSimon Wells-Cole Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author , Simon PhippsSimon Phipps Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author , Ben G. ThomasBen G. Thomas Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author , Antony C.P. RiddickAntony C.P. Riddick Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author , S. Alan McNeillS. Alan McNeill Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author , and David A. TolleyDavid A. Tolley Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.12.006AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compare the outcomes of endoscopic surgery to laparoscopic nephroureterectomy for the management of specifically noninvasive upper tract urothelial carcinoma. Materials and Methods: A retrospective database review identified consecutive patients with clinically noninvasive upper tract urothelial carcinoma who underwent endoscopic surgery (59, via ureteroscopic ablation or percutaneous resection) or laparoscopic nephroureterectomy (70) at a single center during 20 years (1991 to 2011). Overall survival, upper tract urothelial carcinoma specific survival, upper tract recurrence-free survival, intravesical recurrence-free survival, progression-free survival and renal unit survival were estimated using Kaplan-Meier methods, with differences assessed using the log rank test. Results: Median age and followup were 74.8 years and 50 months, respectively. Overall renal preservation in the endoscopic group was high (5-year renal unit survival 82.5%), although this came at a cost of high local recurrence (endoscopic surgery 5-year recurrence-free survival 49.3%, laparoscopic nephroureterectomy 100%, p <0.0001). For G1 upper tract urothelial carcinoma, endoscopic surgery 5-year disease specific survival (100%) was equivalent to that of laparoscopic nephroureterectomy (100%). However, laparoscopic nephroureterectomy demonstrated superior disease specific survival to endoscopic surgery for G2 disease (91.7% vs 62.5%, p = 0.037) and superior progression-free survival for G3 disease (88.9% vs 55.6%, p = 0.033). Conclusions: For G1 upper tract urothelial carcinoma, endoscopic management can provide effective oncologic control and renal preservation. However, endoscopic management should not be considered for higher grade disease except in compelling imperative cases or in patients with poor life expectancy as oncologic outcomes are inferior to those of laparoscopic nephroureterectomy. References 1 : European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol2011; 59: 584. Google Scholar 2 : Cancer statistics, 2012. 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Google Scholar 20 : Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol2012; 62: 100. Google Scholar 21 : Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma. J Urol2007; 177: 1721. Link, Google Scholar 22 : Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. Urology2008; 71: 713. Google Scholar 23 : Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol1997; 157: 33. Link, Google Scholar 24 : Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management. Urology2011; 78: 82. Google Scholar 25 : Role of ureteroscopic biopsy in the management of upper urinary tract malignancy. Int J Urol2003; 10: 627. Google Scholar 26 : Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology2007; 70: 252. Google Scholar 27 : Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma. J Endourol2008; 22: 71. Google Scholar 28 : Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol2010; 184: 69. Link, Google Scholar 29 : A critical appraisal of the classification of urothelial tumours: time for a review of the evidence and a radical change?. BJU Int2007; 99: 723. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byVilla L, Haddad M, Capitanio U, Somani B, Cloutier J, Doizi S, Salonia A, Briganti A, Montorsi F and Traxer O (2018) Which Patients with Upper Tract Urothelial Carcinoma Can be Safely Treated with Flexible Ureteroscopy with Holmium:YAG Laser Photoablation? Long-Term Results from a High Volume InstitutionJournal of Urology, VOL. 199, NO. 1, (66-73), Online publication date: 1-Jan-2018.Laguna M (2018) Re: Oncologic Outcomes of Kidney-Sparing Surgery versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-Muscle Invasive Bladder Cancer Guidelines PanelJournal of Urology, VOL. 197, NO. 6, (1437-1438), Online publication date: 1-Jun-2017.Seisen T, Nison L, Remzi M, Klatte T, Mathieu R, Lucca I, Bozzini G, Capitanio U, Novara G, Cussenot O, Compérat E, Renard-Penna R, Peyronnet B, Merseburger A, Fritsche H, Hora M, Shariat S, Colin P and Rouprêt M (2018) Oncologic Outcomes of Kidney Sparing Surgery versus Radical Nephroureterectomy for the Elective Treatment of Clinically Organ Confined Upper Tract Urothelial Carcinoma of the Distal UreterJournal of Urology, VOL. 195, NO. 5, (1354-1361), Online publication date: 1-May-2016. Volume 189Issue 6June 2013Page: 2054-2061Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsureteroscopyureterurinary tractcarcinoma, transitional cellkidneyMetricsAuthor Information Mark L. Cutress Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Grant D. Stewart Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author Edward C.G. Tudor Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Eric A. Egong Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author Simon Wells-Cole Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Simon Phipps Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Ben G. Thomas Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Antony C.P. Riddick Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author S. Alan McNeill Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, United Kingdom More articles by this author David A. Tolley Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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