Abstract
INTRODUCTION AND OBJECTIVE: Endoscopic management of upper tract urothelial cancer (UTUC) is a nephron-sparing approach that can be offered electively to patients with unifocal disease, lesion < 2 cm and without invasive aspect on CT scan, though these parameters can be extended in imperative cases. In this video we show step-by-step how the latest technologies can be used in order to optimise the outcomes of the endoscopic technique. METHODS: From January 2015 to December 2018, a single centre cohort of 260 patients with suspected UTUC approached endoscopically were retrospectively evaluated. Ureteroscopy was curried out anterogradely or retrogradely. The Storz flex XC image system was used in order to improve lesions detection; when possible real-time tumours characterization was performed with the CLE (Cellvizio). Tumours sampling were performed with 3Fr forceps, Bigopsy or 1.8,2.2Fr nitinol basket.When appropriate according to tumour/patients characteristics, laser ablation was performed with holmium, thulium or their combination.Peri-operative Mitomycin was instilled in the upper tract or in the bladder as appropriate RESULTS: 186 patients with at least 1-year follow-up were analyzed; laser ablation was undertaken in 59 patients, 49 electively and 10 imperatively. Patients and tumours characteristics are in Table 1. Mean operative time was 97 min [50-178]. CLE was performed in 23 patients, identifying 13 low-grade (LG), 9 high-grade (HG) tumours and 1/1 carcinoma in situ, founding 84.6%, 66% and 100% of concordance with histology. Laser ablation was undertaken with Holmium, Thulium or their combination in 43, 6 and 10 patients, respectively. Peri-operative MMC was instilled in the upper tract or in the bladder in 18 and 2 cases, respectively. No Clavien ≥3 complications have been recorded within 30-days post-op. Median hospital stay was 3 days [2-10]. At a median 24-month follow-up[12-50], 30 (49%) patients experienced disease recurrence and 8 (13.5%) progression requiring surgical resection, respectively, with no difference within the grade subgroups. Figure(1 a-b) CONCLUSIONS: New technologies may optimise oncologic outcomes of patients selected for endoscopic management of UTUC, even in HG tumours: standardisation of technique and careful selection of patients is mandatorySource of Funding: none
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