title: Kidney-sparing surgery for upper tract urothelial cancer.
abstract: OBJECTIVE
  This article reviews and summarizes current knowledge on kidney-sparing surgery (KSS) for upper tract urothelial carcinoma (UTUC).
  
  
  RESULTS
  Radical nephroureterectomy (RNU) has been central to the treatment of UTUC for decades, but KSS has been applied to a rising number of patients to preserve renal function. Ablation or resection through flexible ureteroscopy or the percutaneous route seems to provide comparable cancer-specific survival and overall survival to RNU, but the risk of local and bladder recurrence remains relatively high. Segmental ureterectomy is used for low-risk unifocal UTUC with recent studies confirming its oncologic safety and equivalence to RNU. Antegrade or retrograde instillation therapy may be considered as adjuvant treatment after conservative surgery, but their efficacy needs to be proven. Intravesical single-dose chemotherapy is likely to become part of the therapy algorithm of UTUC treated by KSS or RNU to lower bladder seeding and recurrence. Postoperative vigilant radiographic and endoscopic surveillance are obligatory because of the high probability of recurrence.
  
  
  CONCLUSIONS
  KSS should be regarded as a valid alternative to RNU in case of technically resectable low-risk upper tract urothelial cell carcinoma, even in case of a normal contralateral kidney. Advances in technology and biological and clinical risk estimation will make the management of UTUC more evidence based thereby lowering overtreatment.
authors.affiliation: aDepartment of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria bDepartment of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland cDepartment of Urology, Hôpital Pitié-Salpétrière, Université Paris 6, Paris, France.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lucca
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D009392:Nephrectomy; D059351:Organ Sparing Treatments / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy