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Abstract

The rarity of upper tract urothelial carcinoma (UTUC) makes it a difficult disease process to study and, until a recent large multi-institutional collaboration in 2009, 1 Margulis V. Shariat S.F. Matin S.F. et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115: 1224-1233 Crossref PubMed Scopus (773) Google Scholar our basic understanding of pathological characteristics, risk factors, and clinical outcomes for UTUC were extrapolated from small, single-institution studies. The American Cancer Society reports that approximately 5212 renal pelvic tumors and 2710 new cases of ureteral UTUC will be diagnosed in the United States in 2013. 2 Siegel R. Naishadham D. Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013; 63: 11-30 Crossref PubMed Scopus (11434) Google Scholar Thus, approximately one third of UTUCs are ureteral tumors. Our study and another population-based investigation indicate that actuarial utilization of partial ureterectomy (PU) is approximately 10%. 3 Lughezzani G. Jeldres C. Isbarn H. et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009; 45: 3291-3297 Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar Although all ureteral tumors are certainly not amenable to PU, the discrepancy between incidence of ureteral tumors and utilization of PU suggests that PU may be underutilized, and this warrants a closer look. Current evidence-based recommendations for incorporation of PU for UTUC are limited but do indicate that PU may be used for both low and high-risk tumors. 4 Rouprêt M. Zigeuner R. Palou J. et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol. 2011; 59: 584-594 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar Our data supports the concept of expanding the indication for PU to maintain glomerular reserve while not compromising oncologic efficacy. Along with the attendant health benefits of better renal function, PU may also allow for administration of effective adjuvant chemotherapy regimens in patients with advanced stage disease that have greater than 50% mortality at 5 years. 1 Margulis V. Shariat S.F. Matin S.F. et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115: 1224-1233 Crossref PubMed Scopus (773) Google Scholar Our data highlights considering alternative management options as opposed to reflexively performing radical nephroureterectomy (RNU). Editorial CommentUrologyVol. 81Issue 5PreviewPatients harboring upper tract urothelial cancer (UTUC) with coexistent medical renal disease are at an increased risk of progression to endstage renal disease after a radical surgery. For this reason, nephron-sparing approaches in the form of either retrograde or percutaneous endoscopic ablation or resection, as well as segmental ureteral resection with anastomosis, reimplantation, or even ureteral replacement have all been used to achieve oncological control as well as maintain acceptable residual renal function. Full-Text PDF