[Are there indications for organ-preserving tumor resection in urothelial cancers of the upper urinary tract?].
OBJECTIVE
Identification of prognostic factors for tumor recurrence in nephronsparing surgery and tumor progression after organ-preserving surgery.


METHODS
From June 1989 to February 2003, 43 patients (47 nephron units) underwent organ-preserving surgery or the upper urinary tract because of urothelial carcinoma, with 26 (60.5 %) having an elective indication (healthy contralateral kidney).


RESULTS
The mean follow-up was 39.2 months with a range of 10.6 to 168.3 months. Ipsilateral recurrences occurred in 13 (27.6 %) of reno-ureteral units. Recurrences were significantly more common for tumors located in the renal pelvis or opposite the ureteral origin (p = 0.018). Tumor progression occurred in 8 of 43 patients (18.6 %) and significantly correlated with the T- and G-stage of the primary tumor (p = 0.006 and p = 0.002). Of the 47 conservatively treated reno-ureteral units, 38 (80.8 %) could be preserved.


CONCLUSIONS
Organ-preserving resection of the urothelial carcinoma of the upper urinary tract is an alternative in some patients with well-differentiated superficial tumors. A follow-up for life and a good patient compliance are necessary. Tumors of the renal pelvis have a significantly higher recurrence rate than ureteral tumors. Poorly differentiated tumors should undergo organ-preserving surgery only if the goal is palliation and in patients with solitary kidney after intensive consultation about the high risk of invasive recurrences and the development of metastases.
Ubrig
B
B
Klinik für Urologie und Kinderurologie, Univ. Witten/Herdecke, HELIOS-Klinikum Wuppertal. bubrig@wuppertal.helios-kliniken.de
Renner
K
K
Fallahi
M
M
Roth
S
S
D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000209:etiology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014567:Urography