Home > Journals > Minerva Urology and Nephrology > Past Issues > Articles online first > Minerva Urologica e Nefrologica 2020 Feb 19

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

 

Minerva Urologica e Nefrologica 2020 Feb 19

DOI: 10.23736/S0393-2249.20.03710-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Conservative treatment of upper urinary tract carcinoma in patients with imperative indications

Silvia PROIETTI 1 , Michele MARCHIONI 2, Brian H. EISNER 3, Roberta LUCIANÒ 4, Giuseppe SAITTA 1, Moises E. RODRÍGUEZ-SOCARRÁS 1, Carlo D’ORTA 2, Piera BELLINZONI 1, Luigi SCHIPS 2, Franco GABOARDI 1, Guido GIUSTI 1

1 Department of Urology, IRCCS San Raffaele Hospital, Ville Turro, Milan, Italy; 2 Urology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University of Chieti, Chieti, Italy; 3 Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; 4 Pathology Unit, IRCCS San Raffaele Hospital, Milan, Italy


PDF


BACKGROUND: To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management.
METHODS: Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson comorbidity index (CCI).
The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence- free survival (RFS) rates, complication rates and global renal function.
RESULTS: A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0- 79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4 ± 3.5% and the 24-month RFS was 31.7 ± 9.4%. Lower RFS rates were found in high grade tumor patients (22.2 ± 13.9%) compared to low grade tumor patients (35.6 ± 12.3%) (p=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (p=0.018 and p=0.005, respectively).
CONCLUSIONS: Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow- up is necessary due to the high risk of disease recurrence.


KEY WORDS: Utuc; Upper urinary trac carcinoma; Conservative treatment; Solitary kidney; Kidney-sparing surgery

top of page