Modern Kidney-Sparing Management of Upper Tract Urothelial Carcinoma

SIMPLE SUMMARY: Upper tract urothelial carcinoma (UTUC) is a lethal cancer of the urinary tract. Radical nephroureterectomy with bladder cuff excision is the gold standard for the management of patients with UTUC. Nevertheless, less-invasive surgeries to preserve maximum kidney function, such as endoscopic ablation and segmental ureteral resection, have become the preferred options in select patients. In this paper, we reviewed the latest evidence on the kidney-sparing management of upper tract urothelial carcinoma. We showed that these approaches are acceptable for low- as well as select high-risk patients who are not eligible for radical treatments. The main advantages of such approaches include renal function preservation as well as decreased surgical morbidity associated with radical treatments. ABSTRACT: Purpose: To review the latest evidence on the modern techniques and outcomes of kidney-sparing surgeries (KSS) in patients with upper tract urothelial carcinoma (UTUC). Methods: A comprehensive literature search on the study topic was conducted before 30 April 2023 using electronic databases including PubMed, MEDLINE, and EMBASE. A narrative overview of the literature was then provided based on the extracted data and a qualitative synthesis of the findings. Results: KSS is recommended for low- as well as select high-risk UTUCs who are not eligible for radical treatments. Endoscopic ablation is a KSS option that is associated with similar oncological outcomes compared with radical treatments while preserving renal function in well-selected patients. The other option in this setting is distal ureterectomy, which has the advantage of providing a definitive pathological stage and grade. Data from retrospective studies support the superiority of this approach over radical treatment with similar oncological outcomes, albeit in select cases. Novel chemoablation agents have also been studied in the past few years, of which mitomycin gel has received FDA approval for use in low-risk UTUCs. Conclusion: KSSs are acceptable approaches for patients with low- and select high-risk UTUCs, which preserve renal function without compromising the oncological outcomes.