Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience

Objective: Radical nephroureterectomy with bladder-cuff excision has been the traditional treatment for upper tract urothelial carcinoma because of its high rate of recurrence. However, given the morbidity of nephrectomy and the risk of developing chronic kidney disease or dialysis-dependent renal f...

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Main Authors: Yen-Hsi Lee, Henry Y. Lin, Chung-Hsien Chen, Yu-Chi Chen, Ching-Yu Huang, Kevin Lu, Chao-Yang Jiang, Hua-Pin Wang, Victor C. Lin
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2017-12-01
Series:Urological Science
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S1879522617300015
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spelling doaj-bcdc97cebdee4d42a1661543c16a7fa12020-11-24T22:47:53ZengWolters Kluwer Medknow PublicationsUrological Science1879-52262017-12-0128420620910.1016/j.urols.2016.12.002Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experienceYen-Hsi Lee0Henry Y. Lin1Chung-Hsien Chen2Yu-Chi Chen3Ching-Yu Huang4Kevin Lu5Chao-Yang Jiang6Hua-Pin Wang7Victor C. Lin8Department of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanDepartment of Urology, E-DA Hospital, Kaohsiung, TaiwanObjective: Radical nephroureterectomy with bladder-cuff excision has been the traditional treatment for upper tract urothelial carcinoma because of its high rate of recurrence. However, given the morbidity of nephrectomy and the risk of developing chronic kidney disease or dialysis-dependent renal failure, the nephron-sparing approach may be preferable in selected patients. Materials and methods: A total of 118 patients who received unilateral distal ureterectomy with reimplantation at a single center in Taiwan were included, using surgical code numbers, from March 2006 to December 2014. A total of 82 patients were excluded due to nonmalignancy and 17 due to concomitant bladder cancer. Finally, 19 patients with primary, solitary, unilateral ureter lesions and confirmed to have ureter malignancy (urothelial carcinoma, n = 18; squamous cell carcinoma, n = 1) were included. Results: Of the 19 patients (13 males and 6 females) included, the mean age was 69.3 ± 10.7 years. Tumor pathological staging was Tis (n = 1), Ta (n = 3), T1 (n = 2), T2 (n = 6), and T3 (n = 5). Histopathology grading was low grade (n = 3) and high grade (n = 13). No local recurrence was noted; nine patients had bladder recurrence (47.4%), three had distant metastasis (15.8%), and two had progression and finally underwent radical nephroureterectomy (10.5%). The mean time to bladder recurrence was 12.4 months (3–24 months); the mean follow-up time was 28.1 months (1–90 months). The 5-year overall survival rate was 73.7% (14/19); four patients were lost to follow-up, and one patient expired. The mean 5-year progression-free survival was 67.74%. The mean preoperative creatinine level was 1.61 mg/dL, and at 12 months after operation it was 1.56 mg/dL (p = 0.95). Conclusion: In selected patients, distal ureterectomy with reimplantation, in our experience, is a feasible option for distal ureter tumor. Favorable postoperative outcomes with a low local recurrence rate, a low rate of progression to nephroureterectomy, and renal function preservation may prove the value of this modality and should be taken into consideration in suitable patients.http://www.sciencedirect.com/science/article/pii/S1879522617300015distal ureter cancerdistal ureterectomynephron-sparing management
collection DOAJ
language English
format Article
sources DOAJ
author Yen-Hsi Lee
Henry Y. Lin
Chung-Hsien Chen
Yu-Chi Chen
Ching-Yu Huang
Kevin Lu
Chao-Yang Jiang
Hua-Pin Wang
Victor C. Lin
spellingShingle Yen-Hsi Lee
Henry Y. Lin
Chung-Hsien Chen
Yu-Chi Chen
Ching-Yu Huang
Kevin Lu
Chao-Yang Jiang
Hua-Pin Wang
Victor C. Lin
Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
Urological Science
distal ureter cancer
distal ureterectomy
nephron-sparing management
author_facet Yen-Hsi Lee
Henry Y. Lin
Chung-Hsien Chen
Yu-Chi Chen
Ching-Yu Huang
Kevin Lu
Chao-Yang Jiang
Hua-Pin Wang
Victor C. Lin
author_sort Yen-Hsi Lee
title Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
title_short Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
title_full Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
title_fullStr Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
title_full_unstemmed Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience
title_sort nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: a single-center experience
publisher Wolters Kluwer Medknow Publications
series Urological Science
issn 1879-5226
publishDate 2017-12-01
description Objective: Radical nephroureterectomy with bladder-cuff excision has been the traditional treatment for upper tract urothelial carcinoma because of its high rate of recurrence. However, given the morbidity of nephrectomy and the risk of developing chronic kidney disease or dialysis-dependent renal failure, the nephron-sparing approach may be preferable in selected patients. Materials and methods: A total of 118 patients who received unilateral distal ureterectomy with reimplantation at a single center in Taiwan were included, using surgical code numbers, from March 2006 to December 2014. A total of 82 patients were excluded due to nonmalignancy and 17 due to concomitant bladder cancer. Finally, 19 patients with primary, solitary, unilateral ureter lesions and confirmed to have ureter malignancy (urothelial carcinoma, n = 18; squamous cell carcinoma, n = 1) were included. Results: Of the 19 patients (13 males and 6 females) included, the mean age was 69.3 ± 10.7 years. Tumor pathological staging was Tis (n = 1), Ta (n = 3), T1 (n = 2), T2 (n = 6), and T3 (n = 5). Histopathology grading was low grade (n = 3) and high grade (n = 13). No local recurrence was noted; nine patients had bladder recurrence (47.4%), three had distant metastasis (15.8%), and two had progression and finally underwent radical nephroureterectomy (10.5%). The mean time to bladder recurrence was 12.4 months (3–24 months); the mean follow-up time was 28.1 months (1–90 months). The 5-year overall survival rate was 73.7% (14/19); four patients were lost to follow-up, and one patient expired. The mean 5-year progression-free survival was 67.74%. The mean preoperative creatinine level was 1.61 mg/dL, and at 12 months after operation it was 1.56 mg/dL (p = 0.95). Conclusion: In selected patients, distal ureterectomy with reimplantation, in our experience, is a feasible option for distal ureter tumor. Favorable postoperative outcomes with a low local recurrence rate, a low rate of progression to nephroureterectomy, and renal function preservation may prove the value of this modality and should be taken into consideration in suitable patients.
topic distal ureter cancer
distal ureterectomy
nephron-sparing management
url http://www.sciencedirect.com/science/article/pii/S1879522617300015
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