Transitional cell carcinoma of the upper urinary tract: analysis of morphology and distribution for surgical management.
Two series of transitional cell carcinomas (TCC), one including 49 renal pelvic and/or ureteral cancers and the other 29 bladder cancers with concomitant ureteral involvement, were reviewed to establish the criteria for nephron-sparing surgery and for selecting the most appropriate surgical intervention for TCCs at the ureterovesical junction. The following categorization of tumors was made possible by histological mappings of step-sectioned surgical specimens from various surgical modes: 1) low grade papillary superficial tumor, 2) high grade papillary or non-papillary tumor with adjacent or skipped carcinoma in situ (CIS), 3) high grade non-papillary invasive tumor without CIS, 4) high grade papillary superficial tumor without CIS. We can, by comparing postoperative clinical courses, select the mode of surgery in the following manner: 1) nephron-sparing surgery could be indicated in cases of low grade papillary tumor so far as a complete resection is possible; 2) in a case of high grade papillary or non-papillary tumor with adjacent or skipped CIS, extended resection of the urinary tract is required; 3) in a case of high grade non-papillary tumor without CIS, complete en bloc resection of the tumor site, including surrounding organs, will be necessary. The possibility of organ-sparing surgery for early stage cancer without CIS at the ureterovesical junction has been suggested. Preoperative consideration of the above classifications for conservative surgery is also discussed.
Fujimoto
H
H
Division of Urology, National Cancer Center Hospital, Tokyo.
Tobisu
K
K
Mizutani
T
T
Sakamoto
M
M
Kakizoe
T
T
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*