Comparison of open nephroureterectomy and open conservative management of upper urinary tract transitional cell carcinoma.
BACKGROUND
The treatment preserving the kidney for upper urinary tract (UUT) transitional cell carcinoma (TCC) is still controversial. We aimed to elucidate the results of open conservative surgery and compare them with the results of radical nephroureterectomy (RNU).


METHODS
The study included 107 patients with UUT TCC treated by open conservative surgery (21 patients) or nephroureterectomy (86 patients). Epidemiological, clinical and pathological characteristics of patients as well as 5-year survival rates were compared between groups.


RESULTS
Patients treated by conservative surgery had a significantly higher rate of bilateral tumors (38% vs. 3%, p = 0.0001) and smaller tumor size than those treated by radical operations (2.60 +/- 1.24 vs. 3.99 +/- 3.94 cm, p = 0.060). Five-year survival rates for patients treated by conservative and radical surgery were 59 and 55%, respectively. Within the group of patients treated by conservative surgery, 5-year overall survival rates of patients operated due to imperative and elective indications were 41 and 75%, respectively. In univariate analysis, RNU was a statistically significant predictor of poorer outcome of the disease in comparison with conservative surgery (HR = 2.2, 95% CI 1.1-4.6, p = 0.030).


CONCLUSIONS
The mode of operation affects the outcome of UUT TCC patients, in addition to factors such as tumor grade, stage and size.
Institute of Urology and Nephrology, Clinical Centre of Serbia, Belgrade, Serbia. dragidej@eunet.yu
Dejan
D
Dragicevic
Milan
M
Djokic
Tatjana
T
Pekmezovic
Aleksandar
A
Vuksanovic
Sava
S
Micic
Jovan
J
Hadzi-Djokic
Cane
C
Tulic
Dragica
D
Milenkovic
Marija
M
Pljesa-Ercegovac
Tatjana
T
Simic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*