Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for suspected upper tract urothelial carcinoma
BAUS ePoster online library. Villà Freixa S. Jun 24, 2019; 259454; P1-1
Dr. Salvador Villà Freixa
Dr. Salvador Villà Freixa
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Abstract
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INTRODUCTION

Upper tract urothelial carcinoma (UTUC) is uncommon, accounting for 5-10% of all urothelial carcinomas (UC), and current gold standard management consists of radical nephro-ureterectomy (RNU) leading to loss of half the patient's functioning nephrons. Percutaneous nephron-sparing surgery (PCNSS) is an alternative minimally-invasive approach in selected cases where nephron preservation is desired. The long-term outcomes of this procedure at a single centre are described.

METHODS

All patients undergoing PCNSS, with the operation carried out by a single surgeon, were included. Equipment used was a standard 26Ch resectoscope through a 30Ch Amplatz sheath. Data for each patient was collected on the tumour size, location, grade and stage, and overall survival measured in years. Outcomes were compared to pre-existing literature on this particular technique.

RESULTS

15 patients in total underwent PCNSS, with follow-up ranging from 8-22 years (median 11.5 years). 13 patients were diagnosed with UTUC, with 1 proven to have benign disease histologically (leiomyoma). Overall survival at 5 and 10 years was 93.3% and 80% respectively, with disease-specific mortality at 10 years of 13.3% (2 patients who developed metastatic carcinoma). 33% of patients required subsequent RNU for recurrent ipsilateral UTUC. None of the patients had seeding of the percutaneous tract. These figures are comparable to published literature on this procedure.

CONCLUSION

PCNSS for UTUC is a feasible approach to consider in carefully selected patients who agree to intensive follow-up, even for higher grade tumours. Where recurrent UTUC occurs, further management options still exist for disease treatment.
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