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Minerva Urologica e Nefrologica 2020 Feb 19

DOI: 10.23736/S0393-2249.20.03710-8


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


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

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