title: Elective management of transitional cell carcinoma of the distal ureter: can kidney-sparing surgery be advised?
abstract: OBJECTIVE
  To determine the long-term oncological outcome of patients with primary transitional cell carcinoma (TCC) of the distal ureter electively treated with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU) in a retrospective, non-randomized, single-centre study.
  
  
  METHODS
  Of 43 consecutive patients with a primary solitary distal ureter TCC, 19 had KSS, consisting of distal ureter resection with bladder cuff excision and ureter reimplantation, and 24 had RNU with bladder cuff excision.
  
  
  RESULTS
  The median (range) age at surgery was 69 (31-86) years for the KSS group and 73 (59-87) years for the RNU group, patients in the latter having worse hydronephrotic kidneys. The median (range) follow-up was 58 (3-260) months. A recurrent bladder tumour was diagnosed after a median of 15 months in five of the 19 patients treated by KSS and after a median of 5.5 months in eight of the 24 treated by RNU. Five of the 19 patients treated by KSS and six of the 24 treated by RNU died from metastatic disease despite chemotherapy. Recurrence-free, cancer-specific and overall survival were comparable in the two groups. In two patients (11%) treated by KSS an ipsilateral upper urinary tract TCC recurred after 42 and 105 months, respectively.
  
  
  CONCLUSIONS
  Treatment by distal ureteric resection is feasible in patients with primary TCC of the distal ureter. The long-term oncological outcome seems to be comparable with that of patients treated by RNU. Furthermore, kidney preservation is advantageous if adjuvant or salvage chemotherapy is required.
authors.affiliation: Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.forename: Martin C
authors.initials: MC
authors.lastname: Schumacher
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Alain
authors.initials: A
authors.lastname: Bitton
authors.forename: Achim
authors.initials: A
authors.lastname: Fleischmann
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000473:pathology / Q000601:surgery; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery