Long-term outcomes of immediate versus delayed nephroureterectomy for upper tract urothelial carcinoma.

Published

Journal Article

PURPOSE: To compare immediate nephroureterectomy with delayed nephroureterectomy after a trial of nephron-sparing endoscopic surgery in patients who were treated initially at our institution from 1996 to 2004 for upper tract urothelial carcinoma. Patients were monitored for upper tract recurrences, metastases, cancer-specific and overall survival. Survival outcomes and perioperative measurements were compared between treatment groups. RESULTS: Of 73 patients, 62 underwent immediate nephroureterectomy and 11 proceeded to nephroureterectomy after failed endoscopic management. Mean follow-up for all patients was 58 months and 75 months for patients who were alive at last follow-up. Patients treated initially with endoscopy averaged a surveillance procedure every 3.7 months and had a median delay to nephroureterectomy of 10 months. Perioperative measurements at time of nephroureterectomy did not differ between groups. Overall survival 5 years from initial resection in the delayed group and from nephroureterectomy in the immediate group was 64% and 59%, respectively; the corresponding 5-year cancer-specific and metastasis-free survival estimates were 91% vs 80% and 77% vs 73%, respectively (P>0.05). Pathologic progression from low to high-grade occurred in three of seven patients from the delayed group. CONCLUSIONS: Failure of endoscopic management necessitating nephroureterectomy does not appear to affect survival outcomes compared with immediate nephroureterectomy in patients with upper tract urothelial carcinoma. A trial of endoscopic management can be considered in patients with low-grade disease and a normal contralateral kidney. Endoscopy is a viable option when there are imperative indications for nephron sparing in the setting of high-grade disease.

Full Text

Duke Authors

Cited Authors

  • Gadzinski, AJ; Roberts, WW; Faerber, GJ; Wolf, JS

Published Date

  • May 2012

Published In

Volume / Issue

  • 26 / 5

Start / End Page

  • 566 - 573

PubMed ID

  • 21879886

Pubmed Central ID

  • 21879886

Electronic International Standard Serial Number (EISSN)

  • 1557-900X

Digital Object Identifier (DOI)

  • 10.1089/end.2011.0220

Language

  • eng

Conference Location

  • United States