Segmental Ureterectomy is Acceptable for High-risk Ureteral Carcinoma Comparing to Radical Nephroureterectomy

ABSTRACT

Purpose: To determine if segmental ureterectomy (SU) could be chosen for wider oncological indications than low-risk ureteral carcinoma, given the difficulties in accurate preoperative risk stratification determination and kidney-sparing needs for successive therapy. Methods: Data from ureteral carcinoma patients who underwent open SU or laparoscopic radical nephroureterectomy (RNU) between 2011 and 2016 were retrospectively reviewed. Kaplan–Meier survival analysis and Cox regression model with patients' baseline characteristics (age, bladder cancer history, hydronephrosis), procedure type, and tumor characteristics (site, size, pathological features) as covariates were used to evaluate oncological outcomes. Life quality parameters including preoperative renal function, Karnofsky performance status, pain score, and surgical complications were set as second endpoints. Results: Sixty-three patients (24 in SU group, 39 in RNU group) who had at least one high-risk factor were enrolled. In the mean follow-up time of 24.67 months, no significant difference was found in recurrence-free survival (66.7% and 69.2%, p = 0.798), overall survival (79.2% and 84.6%, p = 0.453), and cancer-specific survival (83.3% and 89.7%, p = 0.405) between SU and RNU groups. The Cox regression demonstrated that procedure type was not associated with oncological outcomes. Patients in SU group experienced significant mean estimated glomerular filtration rate (eGFR) increase by 4.60 ml/(min·1.73 m²) (p < 0.001). Proportion of patients having poor eGFR also decreased postoperatively in SU group. Mere tendency in physical performance status improvement and serious complications reduction was detected in SU group. Conclusion: SU is acceptable for high-risk ureteral carcinoma comparing to RNU with satisfying tumor control efficacy and advantage in renal function preservation.

Keywords:

• high-risk ureteral carcinoma
• segmental ureterectomy
• radical nephroureterectomy
• oncological outcome
• life quality outcome

This article is referred to by:

Has Segmental Ureterectomy Now Become an Alternative Treatment to Radical Nephroureterectomy?

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

ACKNOWLEDGMENTS

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Deep gratitude needs to be showed to Dr. Rongyan Huang for her help in writing assistance and proof reading.