title: Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel.
abstract: There is uncertainty regarding the oncologic effectiveness of kidney-sparing surgery (KSS) compared with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
  
  
  
  To systematically review the current literature comparing oncologic outcomes of KSS versus RNU for UTUC.
  
  
  
  A computerised bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting comparative oncologic outcomes of KSS versus RNU. Approaches considered for KSS were segmental ureterectomy (SU) and ureteroscopic (URS) or percutaneous (PC) management. Using the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we identified 22 nonrandomised comparative retrospective studies published between 1999 and 2015 that were eligible for inclusion in this systematic review. A narrative review and risk-of-bias (RoB) assessment were performed using cancer-specific survival (CSS) as the primary end point.
  
  
  
  Seven studies compared KSS overall (n=547) versus RNU (n=1376). Information on the comparison of SU (n=586) versus RNU (n=3692), URS (n=162) versus RNU (n=367), and PC (n=66) versus RNU (n=114) was available in 10, 5, and 2 studies, respectively. No significant difference was found between SU and RNU in terms of CSS or any other oncologic outcomes. Only patients with low-grade and noninvasive tumours experienced similar CSS after URS or PC when compared with RNU, despite an increased risk of local recurrence following endoscopic management of UTUC. The RoB assessment revealed, however, that the analyses were subject to a selection bias favouring KSS.
  
  
  
  Our systematic review suggests similar survival after KSS versus RNU only for low-grade and noninvasive UTUC when using URS or PC. However, selected patients with high-grade and invasive UTUC could safely benefit from SU when feasible. These results should be interpreted with caution due to the risk of selection bias.
  
  
  
  We reviewed the studies that compared kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma. We found similar oncologic outcomes for favourable tumours when using ureteroscopic or percutaneous management, whereas indications for segmental ureterectomy could be extended to selected cases of aggressive tumours.
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris; Pierre et Marie Curie Medical School, University Paris 6, Paris, France. Electronic address: thomas.seisen@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Department of Urology, University of Rennes, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Dominguez-Escrig
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Harman M
authors.initials: HM
authors.lastname: Bruins
authors.affiliation: Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
authors.forename: Cathy Yuhong
authors.initials: CY
authors.lastname: Yuan
authors.affiliation: Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic.
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.affiliation: Department of Urology, HELIOS Agnes-Karll-Krankenhaus, Bad Schwartau, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Böhle
authors.affiliation: Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Pathology, Hôpital La Pitié-Salpétrière, UPMC, Paris, France.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Compérat
authors.affiliation: Radiology Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Cowan
authors.affiliation: Department of Urology, Hyvinkää Hospital, Hyvinkää, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Kaasinen
authors.affiliation: Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.affiliation: Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Bas W G
authors.initials: BW
authors.lastname: van Rhijn
authors.affiliation: European Association of Urology Guidelines Office, Brussels, Belgium.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Sylvester
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris; Pierre et Marie Curie Medical School, University Paris 6, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D006801:Humans; D007668:Kidney; D007680:Kidney Neoplasms / Q000601:surgery*; D000074682:Nephroureterectomy / Q000379:methods*; D059351:Organ Sparing Treatments; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*
keywords: Recurrence; Renal pelvis; Survival; Ureter; Ureteral neoplasms; Ureteroscopy; Urinary tract; Urothelial carcinoma