Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection

To assess oncologic outcomes in patients undergoing percutaneous management for upper urinary tract transitional cell carcinoma (UUT-TCC) of the renal cavities.

We performed a retrospective review of data for patients who underwent percutaneous conservative surgery for a UUT-TCC between 1989 and 2005: sex; age at diagnosis; mode of diagnosis; smoking; history of bladder cancer; type of surgery; complications; tumour site, size, stage and grade, and recurrence and progression. We evaluated recurrence and survival rates.

Data were analyzed for 24 patients. Median age was 70 yr. The tumour was located in the renal pelvis in 11 patients and in the caliceal system in 13 patients. Mean tumour size was 1.8 cm (range: 0.8-2.9). Four patients had a history of bladder carcinoma. Three patients experienced perioperative blood loss requiring transfusion, and one experienced colon wound. Median follow-up was 62 mo. Eight (33.3%) patients experienced local recurrence (three in the treated urinary tract, one in the contralateral tract, four in the bladder). Five patients underwent nephroureterectomy (NUT) during follow-up. Five (20.8%) patients have died, four from disease progression and one from cardiovascular causes. The 5-year disease-specific and tumour-free survival rates were 79.5% and 68%, respectively.

Percutaneous management can be recommended as an alternative to NUT or ureteroscopy for low-grade or superficial UUT-TCCs localised in the renal cavities. These patients require long-term postsurgical surveillance. For patients with high-grade or invasive tumours, open NUT remains the gold standard.