Renal function and oncologic outcomes of parenchymal sparing ureteral resection versus radical nephroureterectomy for upper tract urothelial carcinoma Journal Article

   

Authors:	Silberstein, J. L.; Power, N. E.; Savage, C.; Tarin, T. V.; Favaretto, R. L.; Su, D.; Kaag, M. G.; Herr, H. W.; Dalbagni, G.
Article Title:	Renal function and oncologic outcomes of parenchymal sparing ureteral resection versus radical nephroureterectomy for upper tract urothelial carcinoma
Abstract:	We compared renal function and oncologic outcomes of parenchymal sparing ureteral resection with radical nephroureterectomy for the treatment of upper tract urothelial carcinoma confined to the ureter. Review of a large institutional database identified 367 patients treated for primary upper tract urothelial carcinoma with radical nephroureterectomy or parenchymal sparing ureteral resection from 1994 to 2009. Patients with known renal pelvis tumors, muscle invasive urothelial carcinoma, prior cystectomy, contralateral upper tract urothelial carcinoma, metastatic disease or chemotherapy were excluded, leaving 120 patients for analysis. Estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease equation. Recurrence-free, cancer specific and overall survival were estimated using Kaplan-Meier analysis. Radical nephroureterectomy was performed in 87 patients and parenchymal sparing ureteral resection in 33. Median age at surgery was 73 years in the radical nephroureterectomy group (IQR 6476) vs 70 years (IQR 5977) in the parenchymal sparing ureteral resection group (p = 0.5). The radical nephroureterectomy and parenchymal sparing ureteral resection cohorts had several disparate clinicopathological variables including preoperative hydronephrosis (80% vs 45%, p = 0.0006), stage (pT3 or greater 26% vs 9%, p = 0.01) and baseline estimated glomerular filtration rate (51 vs 63 ml/minute/1.73 m 2, p = 0.009). Patients who underwent radical nephroureterectomy experienced a significantly greater decrease in estimated glomerular filtration rate after surgery (median -7 vs 0 ml/minute/1.73 m 2, p <0.001). Median followup was 4.2 years. Of the patients 79 experienced cancer recurrence and 44 died (28 of upper tract urothelial carcinoma). There were no obvious differences in the rates of recurrence, cancer specific death or overall death by procedure type. However, due to the limited number of events we cannot exclude the possibility that there are large differences in oncologic outcomes by procedure type. Parenchymal sparing ureteral resection is associated with superior postoperative renal function. However, the impact on cancer control cannot be determined conclusively due to the small sample size and putative selection bias. © 2012 American Urological Association Education and Research, Inc.
Keywords:	adult; cancer chemotherapy; cancer survival; controlled study; aged; cancer surgery; major clinical study; overall survival; cancer recurrence; multimodality cancer therapy; outcome assessment; follow up; lymph node dissection; cohort analysis; kidney failure; retrospective study; preoperative period; kidney function; nephroureterectomy; scoring system; carcinoma; intermethod comparison; glomerulus filtration rate; upper tract urothelial carcinoma; ureter; transitional cell carcinoma; transitional cell; hydronephrosis; chronic; cisplatin derivative; ureter surgery; parenchymal sparing ureteral resection
Journal Title:	Journal of Urology
Volume:	187
Issue:	2
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2012-02-01
Start Page:	429
End Page:	434
Language:	English
DOI:	10.1016/j.juro.2011.09.150
PROVIDER:	scopus
PUBMED:	22177163
PMCID:	PMC3689028
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84855602235&partnerID=40&md5=2accf4d478abfe19f31fc50a562c85f8
Notes:	--- - "Export Date: 1 March 2012" - "CODEN: JOURA" - "Source: Scopus"

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