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Oncologic Outcomes of Kidney Sparing Surgery versus Radical Nephroureterectomy for the Elective Treatment of Clinically Organ Confined Upper Tract Urothelial Carcinoma of the Distal Ureter
T. Seisen, L. Nison, M. Remzi, T. Klatte, R. Mathieu, I. Lucca, G. Bozzini, U. Capitanio, G. Novara, O. Cussenot, E. Compérat, R. Renard-Penna, B. Peyronnet, AS. Merseburger, HM. Fritsche, M. Hora, SF. Shariat, P. Colin, M. Rouprêt,
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Time Factors MeSH
- Elective Surgical Procedures methods MeSH
- Incidence MeSH
- Carcinoma, Transitional Cell pathology surgery MeSH
- Laparoscopy methods MeSH
- Humans MeSH
- Neoplasm Recurrence, Local epidemiology MeSH
- Survival Rate trends MeSH
- Ureteral Neoplasms pathology surgery MeSH
- Follow-Up Studies MeSH
- Nephrectomy methods MeSH
- Postoperative Complications epidemiology MeSH
- Disease-Free Survival MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Ureter surgery MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe epidemiology MeSH
PURPOSE: We compared the oncologic outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery for elective treatment of clinically organ confined upper tract urothelial carcinoma of the distal ureter. MATERIALS AND METHODS: From a multi-institutional collaborative database we identified 304 patients with unifocal, clinically organ confined urothelial carcinoma of the distal ureter and bilateral functional kidneys. Rates of overall, cancer specific, local recurrence-free and intravesical recurrence-free survival according to surgery type were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery. RESULTS: Overall 128 (42.1%), 134 (44.1%) and 42 patients (13.8%) were treated with radical nephroureterectomy, distal ureterectomy and endoscopic surgery, respectively. Although rates of overall, cancer specific and intravesical recurrence-free survival were equivalent among the 3 surgical procedures, 5-year local recurrence-free survival was lower for endoscopic surgery (35.7%) than for nephroureterectomy (95.0%, p <0.001) or ureterectomy (85.5%, p = 0.01) with no significant difference between nephroureterectomy and distal ureterectomy. On multivariable analyses only endoscopic surgery was an independent predictor of decreased local recurrence-free survival compared to nephroureterectomy (HR 1.27, p = 0.001) or distal ureterectomy (HR 1.14, p = 0.01). Distal ureterectomy and endoscopic surgery did not significantly correlate to cancer specific or intravesical recurrence-free survival. However, when adjustment was made for ASA(®) (American Society of Anesthesiologists(®)) score, distal ureterectomy (HR 0.80, p = 0.01) and endoscopic surgery (HR 0.84, p = 0.02) were independent predictors of increased overall survival, although no significant difference was found between them. CONCLUSIONS: Because of better oncologic outcomes, distal ureterectomy could be considered the elective first line treatment of clinically organ confined urothelial carcinoma of the distal ureter.
Academic Department of Pathology University Hospital Pitié Salpétrière Paris France
Academic Department of Radiology University Hospital Pitié Salpétrière Paris France
Academic Department of Urology Landesklinikum Korneuburg Korneuburg Austria
Academic Department of Urology Medical University Vienna General Hospital Vienna Austria
Academic Department of Urology St Josef Medical Center University of Regensburg Germany
Academic Department of Urology University Hospital Claude Huriez Lille France
Academic Department of Urology University Hospital Pitié Salpétrière Paris France
Academic Department of Urology University Hospital Pontchaillou Rennes France
Academic Department of Urology University Hospital Schleswig Holstein Lübeck Germany
Department of Surgery Oncology and Gastroenterology Urology Clinic University of Padua Padua Italy
Department of Urology Private Hospital La Louvière Lille France
References provided by Crossref.org
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- $a Oncologic Outcomes of Kidney Sparing Surgery versus Radical Nephroureterectomy for the Elective Treatment of Clinically Organ Confined Upper Tract Urothelial Carcinoma of the Distal Ureter / $c T. Seisen, L. Nison, M. Remzi, T. Klatte, R. Mathieu, I. Lucca, G. Bozzini, U. Capitanio, G. Novara, O. Cussenot, E. Compérat, R. Renard-Penna, B. Peyronnet, AS. Merseburger, HM. Fritsche, M. Hora, SF. Shariat, P. Colin, M. Rouprêt,
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