Endoscopic and minimally invasive approaches to upper tract urothelial carcinoma.
OBJECTIVE
In recent years, minimally invasive techniques have been widely applied to urologic diseases affecting the upper and lower urinary tracts. Technologic advances in both laparoscopy and endoscopy provide an opportunity to improve the treatment of urothelial carcinoma outside the bladder. We review the recent studies relevant to the therapy for urothelial cell carcinoma of the upper urinary tract.


RESULTS
Despite the availability of improved ureteroscopes and newer ablative energy sources, endoscopic management of upper tract urothelial tumors must be approached cautiously. Factors that increase the risk of recurrent or progressive disease include stage, grade, and size. Although percutaneous access permits larger instruments and may improve tumor resection, the outcome is determined by tumor characteristics. Adjuvant therapies, both systemic and local, are still lacking and require further study. Laparoscopic nephroureterectomy is clearly feasible and reduces patient morbidity. The limited data available suggest that oncologic outcomes of laparoscopic nephroureterectomy are comparable to the open operation, although longer follow-up is required. The optimal method of distal ureterectomy, ensuring complete removal of susceptible urothelium, remains to be determined. Adequate care must be taken during specimen retrieval to prevent tumor seeding or spillage.


CONCLUSIONS
Urologists currently have multiple tools to aid in the management of upper urinary tract urothelial tumors with minimal morbidity. Cancer-specific outcomes should, however, remain the primary concern and the development of novel systemic therapies needs to parallel the advances in surgical techniques.
Park
Sangtae
S
Department of Urology, University of California San Francisco, 94143, USA.
Meng
Maxwell V
MV
D002277:Carcinoma / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy; D016896:Treatment Outcome; D018666:Ureteroscopy; D014571:Urologic Neoplasms / Q000601:surgery*