Local excision of urothelial cancer of the upper urinary tract.
In 9 of 93 patients (9.7%) with urothelial cancer of the upper tract (7 renal pelvis tumors, 3 ureteral tumors), conservative surgery was employed using a free peritoneal autotransplant for replacement of the renal pelvis in 5 kidneys. Absolute indications for conservative surgery were solitary kidneys/nonfunctioning contralateral kidneys in 4 patients and bilateral tumors in 1 patient. Local recurrences developed 1-3 years after operation in 4 of 6 kidneys (3 patients), 3 of which had grade-2 and grade-3 primary lesions. All patients were treated successfully by repeated local excision. In the presence of a normal contralateral kidney, local tumor excision was done electively in 4 patients (3 low-grade/low-stage lesions, 1 high-risk patient), none of these patients developed recurrences. Two patients died without evidence of tumor recurrence, 7 patients are free of tumor at an average follow-up of 23 months (range 5-65 months). Local excision of urothelial cancer should be considered not only for solitary kidneys, bilateral tumors and cases with renal failure, but also for low-stage/low-grade localized tumors, leaving the patient better prepared for later treatment of a possible recurrence due to the well recognized chance of a multiplicity of tumors in time and space.
D000328:Adult; D000368:Aged; D004848:Epithelium / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010537:Peritoneum / Q000637:transplantation; D011183:Postoperative Complications; D012086:Reoperation; D014516:Ureteral Neoplasms / Q000601:surgery*