title: Endoscopic treatment of upper tract transitional cell carcinoma.
abstract: OBJECTIVE
  To review the current literature and data describing primary endoscopic treatment of upper tract transitional cell carcinoma (TCC).
  
  
  METHODS
  Published, peer-reviewed articles on ureteroscopic, percutaneous, and laparoscopic treatment of upper tract TCC were identified using the MEDLINE database.
  
  
  RESULTS
  Nephroureterectomy has been considered the "gold standard" for upper tract TCC. Minimally invasive approaches, initially advocated for patients requiring a nephron sparing approach (i.e., solitary kidney or renal insufficiency) or those with significant comorbidities precluding definitive surgery, have been increasingly used with the further refinement of ureteroscopy, percutaneous renal surgery, and laparoscopy. Ureteroscopy has been used successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%. Progression and metastatic rates are low and correlate with tumor grade. Likewise, percutaneous approaches show disease specific survival and recurrence rates correlating with tumor grade. Patients with low-grade tumors (Grades 1-2) do well with this approach with recurrence rates and disease specific survival rates of 26% to 28% and 96% to 100%, respectively. For those patients requiring complete extirpation of the kidney and ureter, laparoscopic nephroureterectomy results in decreased postoperative pain, shorter hospital stay, and more rapid convalescence without compromising cancer control.
  
  
  CONCLUSIONS
  Nephron sparing approaches in well-selected patients with low stage and low-grade disease can be treated endoscopically with ureteroscopy and percutaneous renal surgery. Laparoscopic nephroureterectomy offers a safe, minimally invasive alternative to traditional open surgical techniques for patients with TCC of the upper urinary tract.
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, VA 23510, USA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Soderdahl
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fabrizio
authors.forename: Naeem U
authors.initials: NU
authors.lastname: Rahman
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: Demetrius H
authors.initials: DH
authors.lastname: Bagley
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous; D018579:Patient Selection; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy