title: Oncologic Outcomes of Kidney Sparing Surgery versus Radical Nephroureterectomy for the Elective Treatment of Clinically Organ Confined Upper Tract Urothelial Carcinoma of the Distal Ureter.
abstract: OBJECTIVE
  We compared the oncologic outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery for elective treatment of clinically organ confined upper tract urothelial carcinoma of the distal ureter.
  
  
  METHODS
  From a multi-institutional collaborative database we identified 304 patients with unifocal, clinically organ confined urothelial carcinoma of the distal ureter and bilateral functional kidneys. Rates of overall, cancer specific, local recurrence-free and intravesical recurrence-free survival according to surgery type were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery.
  
  
  RESULTS
  Overall 128 (42.1%), 134 (44.1%) and 42 patients (13.8%) were treated with radical nephroureterectomy, distal ureterectomy and endoscopic surgery, respectively. Although rates of overall, cancer specific and intravesical recurrence-free survival were equivalent among the 3 surgical procedures, 5-year local recurrence-free survival was lower for endoscopic surgery (35.7%) than for nephroureterectomy (95.0%, p <0.001) or ureterectomy (85.5%, p = 0.01) with no significant difference between nephroureterectomy and distal ureterectomy. On multivariable analyses only endoscopic surgery was an independent predictor of decreased local recurrence-free survival compared to nephroureterectomy (HR 1.27, p = 0.001) or distal ureterectomy (HR 1.14, p = 0.01). Distal ureterectomy and endoscopic surgery did not significantly correlate to cancer specific or intravesical recurrence-free survival. However, when adjustment was made for ASA(®) (American Society of Anesthesiologists(®)) score, distal ureterectomy (HR 0.80, p = 0.01) and endoscopic surgery (HR 0.84, p = 0.02) were independent predictors of increased overall survival, although no significant difference was found between them.
  
  
  CONCLUSIONS
  Because of better oncologic outcomes, distal ureterectomy could be considered the elective first line treatment of clinically organ confined urothelial carcinoma of the distal ureter.
authors.affiliation: Academic Department of Urology, University Hospital Pitié Salpétrière, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Academic Department of Urology, University Hospital Claude Huriez, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Nison
authors.affiliation: Academic Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
authors.forename: Mezut
authors.initials: M
authors.lastname: Remzi
authors.affiliation: Academic Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.affiliation: Academic Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.
authors.forename: Romain
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Academic Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lucca
authors.affiliation: Academic Department of Urology, University Hospital Claude Huriez, Lille, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Bozzini
authors.affiliation: Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele University, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Department of Surgery, Oncology and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Academic Department of Urology, University Hospital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.affiliation: Academic Department of Pathology, University Hospital Pitié Salpétrière, Paris, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.affiliation: Academic Department of Radiology, University Hospital Pitié Salpétrière, Paris, France.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.affiliation: Academic Department of Urology, University Hospital Pontchaillou, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Academic Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany.
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.affiliation: Academic Department of Urology, St. Josef Medical Center, University of Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Academic Department of Urology, Faculty Hospital Plzeň and Charles University in Prague, Faculty of Medicine in Plzeň, Plzeň, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Academic Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Private Hospital La Louvière, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.affiliation: Academic Department of Urology, University Hospital Pitié Salpétrière, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France. Electronic address: morgan.roupret@psl.aphp.fr.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: carcinoma; kidney; mortality; ureter; urothelium