Kymora B Scotland1, Nir Kleinmann2, Dillon Cason3, Logan Hubbard3, Ryuta Tanimoto4, Kelly A Healy5, Scott G Hubosky6, Demetrius H Bagley7. 1. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Urology, Sheba Medical Center Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. 4. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 5. Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY. 6. Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA. 7. Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: Demetrius.Bagleyjr@jefferson.edu.
Abstract
OBJECTIVE: To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for upper tract urothelial carcinoma (UTUC) lesions larger than 2 cm. Traditionally, patients with large UTUC are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging METHODS: An institutional database review identified 80 patients with biopsy proven low-grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including demographics, operative parameters, and pathologic features. Follow-up for all patients was standardized and included cystoscopy and URS every 3 months until clear, every 6 months through the fifth year, and yearly thereafter. We calculated rates of recurrence, progression, and overall survival. RESULTS: In total, 86 unique lesions ≥2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5% of tumors had ipsilateral recurrence and 31.7% progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20%); mean time to surgery was 23.2 months. Overall survival was 75%, and cancer specific survival was 84% at 5-year follow-up. CONCLUSION: Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, URS can potentially preserve renal units in patients with large lesions.
OBJECTIVE: To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for upper tract urothelial carcinoma (UTUC) lesions larger than 2 cm. Traditionally, patients with large UTUC are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging METHODS: An institutional database review identified 80 patients with biopsy proven low-grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including demographics, operative parameters, and pathologic features. Follow-up for all patients was standardized and included cystoscopy and URS every 3 months until clear, every 6 months through the fifth year, and yearly thereafter. We calculated rates of recurrence, progression, and overall survival. RESULTS: In total, 86 unique lesions ≥2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5% of tumors had ipsilateral recurrence and 31.7% progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20%); mean time to surgery was 23.2 months. Overall survival was 75%, and cancer specific survival was 84% at 5-year follow-up. CONCLUSION: Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, URS can potentially preserve renal units in patients with large lesions.
Authors: Francesco Soria; M Pilar Laguna; Morgan Roupret; Patricio Garcia-Marchinena; Mariano Sebastián Gonzalez; Tomonori Habuchi; Erkan Erkan; Anthony Ng; Paolo Gontero; Jean de la Rosette Journal: BJU Int Date: 2021-06-13 Impact factor: 5.969
Authors: Jeremy Ng Chieng Hin; Dinul Hettiarachchilage; Paul Gravestock; Bhavan Rai; Bhaskar K Somani; Rajan Veeratterapillay Journal: Curr Urol Rep Date: 2021-10-07 Impact factor: 3.092