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 Faculty Hospital Plzeň and Charles University Prague Faculty of Medicine in Plzeň Plzeň Czech Republic

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; UPMC Universitaire Paris 06 GRC5 ONCOTYPE Uro and Institut Universitaire de Cancérologie Paris France

Academic Department of Urology University Hospital Pontchaillou Rennes France

Academic Department of Urology University Hospital Schleswig Holstein Lübeck Germany

Academic Department of Urology University Hospital Tenon Assistance Publique Hôpitaux de Paris Paris France; UPMC Universitaire Paris 06 GRC5 ONCOTYPE Uro and Institut Universitaire de Cancérologie Paris France

Department of Surgery Oncology and Gastroenterology Urology Clinic University of Padua Padua Italy

Department of Urology Private Hospital La Louvière Lille France

Unit of Urology Division of Oncology Urological Research Institute IRCCS Ospedale San Raffaele University Milan Italy

J Urol. 2016 May;195(5):1360-1361. doi: 10.1016/j.juro.2015.11.082. PubMed

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Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease