[Conservative surgery of upper urinary tract urothelial carcinomas]

In the last ten years 19 patients with urothelial cancer of the upper urinary tract underwent excision of the tumor with preservation of the ipsilateral kidney. Renal function was preserved well in all cases in 31 months of the mean follow up term. In the presence of a normal contralateral kidney, local tumor excision was done electively in 12 patients (5 lower portion of ureter, 5 low grade lesions, 2 high age), local recurrence developed 6-63 months after operation in 2 patients, and they underwent nephroureterectomy. 11 cases are alive with no evidence of disease and one is alive with contralateral renal pelvic cancer. Absolute indications for conservative surgery were solitary kidneys/non functioning contralateral kidney in 3 patients and bilateral tumor in 4 patients. Most tumors were high grade or high stage (6: grade 2,4: PT2). No one had local recurrence, but one had a metastasis to a lung, 4 were suffering from bladder cancer post-operatively. Three patients died from cancer 20-30 months after operation. Local excision of urothelial cancer should be considered not only for cases of contralateral damaged kidneys but also for low grade, low stage localized tumors. Precise preoperative evaluation of tumors using a ureteroenoscope should be made for the indication of the renal preservative operation.