Open surgical partial nephrectomy for upper tract urothelial carcinoma

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Upper tract urothelial carcinoma (UTUC) presents challenges for organ preservation.
• Endoscopic management is often insufficient for certain UTUC cases.
• Nephron-sparing surgery is considered when UTUC is refractory to endoscopic treatment.

Purpose of the Study:

• To evaluate partial nephrectomy's efficacy in preventing end-stage renal disease (ESRD) and tumor recurrence in UTUC patients.
• To assess oncological outcomes and survival following partial nephrectomy for UTUC.
• To determine the role of partial nephrectomy in UTUC management when endoscopic options fail.

Main Methods:

• Retrospective review of eight patients with UTUC undergoing partial nephrectomy.
• Analysis of medical records focusing on indications for nephron sparing and surgical outcomes.
• Assessment of end-stage renal disease development, tumor recurrence, and patient survival post-surgery.

Main Results:

• 25% of patients developed end-stage renal disease; only one required hemodialysis.
• Recurrence rates were 71% (5/7) with adequate surveillance, but 80% (4/5) were successfully managed endoscopically.
• Four patients died within 3.5 years; one from metastatic disease. Four patients survived with a mean follow-up of 71 months without metastatic urothelial cancer.

Conclusions:

• Partial nephrectomy averts end-stage renal disease in most UTUC patients with imperative indications.
• The procedure is associated with acceptable disease-specific survival for UTUC.
• Partial nephrectomy is a viable, albeit sparingly used, option for UTUC refractory to endoscopic management requiring nephron sparing.