Cargando…

Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?

INTRODUCTION: In the management of upper tract urothelial cell carcinoma (UTUC) endoscopic, nephron sparing procedures like ureterorenoscopy (URS) or percutaneous tumour resection (PCTR) still play a very limited role. This could lead to possible unnecessary radical nephroureterectomies (RNU), still...

Descripción completa

Detalles Bibliográficos
Autores principales: Strijbos, Willem E., van der Heij, Bart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Second Military Medical University 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730826/
https://www.ncbi.nlm.nih.gov/pubmed/29264181
http://dx.doi.org/10.1016/j.ajur.2016.04.003
_version_ 1783286417479172096
author Strijbos, Willem E.
van der Heij, Bart
author_facet Strijbos, Willem E.
van der Heij, Bart
author_sort Strijbos, Willem E.
collection PubMed
description INTRODUCTION: In the management of upper tract urothelial cell carcinoma (UTUC) endoscopic, nephron sparing procedures like ureterorenoscopy (URS) or percutaneous tumour resection (PCTR) still play a very limited role. This could lead to possible unnecessary radical nephroureterectomies (RNU), still being the gold standard treatment. The risk of chronic kidney disease (CKD) later in life is important. In this study we present the results of 24-year experience with PCTR in a single institution. METHODS: We identified 44 patients who underwent PCTR between 1992 and 2015. Radical resection was achieved in 40 patients who were included in this study. Demographic and clinical data, including tumour recurrence, progression to RNU, tumour grade and overall survival (OS) were retrospectively acquired. An outcome analysis was conducted. RESULTS: Median age at diagnosis was 68 years (range 42–94 years). Low grade tumours were found in 37 patients (92.5%) and high grade tumours in three patients (7.5%). Median follow-up was 53 months during which 20 patients developed upper tract recurrences (50.0%). The longest time to recurrence was 97 months. At follow-up 11 patients (27.5%) underwent an RNU and two patients died from UTUC. RNU could be avoided in 29 patients (72.5%). In this study we found that multifocality is a significant risk factor for recurrence, but not for stage progression to RNU. CONCLUSION: PCTR is a surgically and oncologically safe procedure. Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients. Selection criteria for PCTR should be further refined, leading to a wider application of PCTR in the future. Follow-up needs invasive procedures and should be long term.
format Online
Article
Text
id pubmed-5730826
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Second Military Medical University
record_format MEDLINE/PubMed
spelling pubmed-57308262017-12-20 Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe? Strijbos, Willem E. van der Heij, Bart Asian J Urol Editorial INTRODUCTION: In the management of upper tract urothelial cell carcinoma (UTUC) endoscopic, nephron sparing procedures like ureterorenoscopy (URS) or percutaneous tumour resection (PCTR) still play a very limited role. This could lead to possible unnecessary radical nephroureterectomies (RNU), still being the gold standard treatment. The risk of chronic kidney disease (CKD) later in life is important. In this study we present the results of 24-year experience with PCTR in a single institution. METHODS: We identified 44 patients who underwent PCTR between 1992 and 2015. Radical resection was achieved in 40 patients who were included in this study. Demographic and clinical data, including tumour recurrence, progression to RNU, tumour grade and overall survival (OS) were retrospectively acquired. An outcome analysis was conducted. RESULTS: Median age at diagnosis was 68 years (range 42–94 years). Low grade tumours were found in 37 patients (92.5%) and high grade tumours in three patients (7.5%). Median follow-up was 53 months during which 20 patients developed upper tract recurrences (50.0%). The longest time to recurrence was 97 months. At follow-up 11 patients (27.5%) underwent an RNU and two patients died from UTUC. RNU could be avoided in 29 patients (72.5%). In this study we found that multifocality is a significant risk factor for recurrence, but not for stage progression to RNU. CONCLUSION: PCTR is a surgically and oncologically safe procedure. Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients. Selection criteria for PCTR should be further refined, leading to a wider application of PCTR in the future. Follow-up needs invasive procedures and should be long term. Second Military Medical University 2016-07 2016-05-27 /pmc/articles/PMC5730826/ /pubmed/29264181 http://dx.doi.org/10.1016/j.ajur.2016.04.003 Text en © 2016 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Editorial
Strijbos, Willem E.
van der Heij, Bart
Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title_full Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title_fullStr Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title_full_unstemmed Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title_short Percutaneous resection of upper tract urothelial cell carcinoma: When, how, and is it safe?
title_sort percutaneous resection of upper tract urothelial cell carcinoma: when, how, and is it safe?
topic Editorial
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730826/
https://www.ncbi.nlm.nih.gov/pubmed/29264181
http://dx.doi.org/10.1016/j.ajur.2016.04.003
work_keys_str_mv AT strijboswilleme percutaneousresectionofuppertracturothelialcellcarcinomawhenhowandisitsafe
AT vanderheijbart percutaneousresectionofuppertracturothelialcellcarcinomawhenhowandisitsafe