title: Complex percutaneous resections for upper-tract urothelial carcinoma.
abstract: OBJECTIVE
  Percutaneous endoscopic resection is a viable treatment option for upper-tract urothelial carcinoma (UC) in selected patients. We present our experience with patients who underwent percutaneous resections for complex urothelial tumors.
  
  
  METHODS
  Patients who were undergoing percutaneous treatment for UC were identified within a prospectively maintained database at a single institution. Charts were reviewed to identify complex patients (n = 16) who met the following criteria: (a) tumor size >2.5 cm (n = 8), (b) preoperative creatinine level >3.0 mg/dL (n = 3), or (c) anatomic variant (cystectomy/urinary diversion [n = 2]; autotransplanted kidney [n = 1]; ipsilateral partial nephrectomy [n = 1]; distal ureterectomy [n = 1]). Demographic, operative, and oncologic data were captured. Recurrence-free, cancer-specific, and overall survivals were calculated and compared with a control group of noncomplex cases (n = 23).
  
  
  RESULTS
  No difference was found in mean age (69.7 +/- 10.8 years vs 69.8 +/- 11.2 years), complication rate (6.3% vs 7.1%), or change in creatinine level (1.53 mg/dL to 1.51 mg/dL vs 1.88 mg/dL to 1.57 mg/dL) between noncomplex and complex cases. The incidences of high-grade tumors (55% vs 71%), invasive tumors (15% vs 20%), solitary kidney (82% vs 92%), contralateral nephroureterectomy (52% vs 60%), and history of bladder cancers (47% vs 38%) were similar between the two groups. Median follow-up was 36 months. No difference was seen in cancer-specific survival (P = 0.98) or recurrence-free survival (P = 0.39). An improved trend in overall survival (P = 0.20) was seen in the noncomplex patients when compared with the complex group.
  
  
  CONCLUSIONS
  These findings suggest that patients with large tumors, poor renal function, and significant anatomic variations may be well served by endoscopic treatment for upper-tract UC when indicated.
authors.affiliation: Steven B. Streem Center for Endourology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Irwin
authors.forename: Andre K
authors.initials: AK
authors.lastname: Berger
authors.forename: Ricardo
authors.initials: R
authors.lastname: Brandina
authors.forename: Robert
authors.initials: R
authors.lastname: Stein
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019990:Perioperative Care; D014057:Tomography, X-Ray Computed; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*