title: Distal ureterectomy is a safe surgical option in patients with urothelial carcinoma of the distal ureter.
abstract: OBJECTIVE
  We evaluated cancer-specific survival (CSS) and recurrence-free survival (RFS) rates of open distal ureterectomy (DU) compared with radical nephroureterectomy (RNU) for urothelial carcinoma of the distal ureter.
  
  
  METHODS
  We retrospectively considered patients with urothelial carcinoma of the distal ureter who underwent DU or RNU at our department. Survival analysis and Cox regression models compared CSS and RNU after DU and RNU. RFS was evaluated separately for bladder and upper tract. Covariates were age, gender, symptoms at diagnosis, pathologic stage and grade, associated carcinoma in situ, surgical margins, lympho-vascular invasion, multifocality, necrosis, and previous or concomitant bladder cancer.
  
  
  RESULTS
  Forty-nine and 42 patients underwent DU and RNU, respectively. Median patients' follow-up was 51.5 months (range 4-290 mo). Two patients (4%) in the DU group were diagnosed with a recurrence in the ipsilateral upper tract after 63 and 45 months, respectively. Both patients underwent nephroureterectomy and are still alive in strict follow-up for non-muscle invasive bladder recurrence. Contralateral upper tract recurrence was observed in 1 and 3 patients in the RNU and DU group, respectively. At 5 years, CSS and RFS (upper tract) rates were 77% and 91% for DU and 78% and 96% for RNU, respectively. On univariable and multivariable analyses the type of surgery did not influence CSS and RFS (P = 0.92 and P = 0.94).
  
  
  CONCLUSIONS
  DU is a safe surgical option in patients with urothelial carcinoma of the distal ureter and does not compromise oncologic outcomes compared with RNU.
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: orietta.dalpiaz@medunigraz.at.
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Ehrlich
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Quehenberger
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Recurrence; Survival; Upper urinary tract; Ureter; Ureterectomy; Urothelial carcinoma