Distant metastasis of urothelial tumors of the renal pelvis and ureter.

Autopsy reports on urothelial tumors of the renal pelvis and ureter in 602 cases were analyzed to investigate the mode of metastasis. Seventy one cases, or 12%, showed no metastasis. Metastasis-free cases occurred with significantly high frequencies in cases of tumors of the ureter and papillomatosis, and less frequently in squamous cell carcinoma cases and in females. Lymph nodes were the most frequent site of dissemination, especially the retroperitoneal and para-aortic lymph nodes. Metastases to the lungs, peritoneum and ipsilateral adrenal were significantly more frequent in cases of tumors of the renal pelvis than in those of tumors of the ureter. Metastases to the retroperitoneal lymph nodes and peritoneum were frequent in cases with metastasis to one organ. Radical nephrectomy with regional lymphadenectomy and/or radiation therapy is indicated for tumors of the renal pelvis. Palliative surgery or nephroureterectomy with a cuff of bladder wall is indicated for tumors of the ureter or papillomatosis, and radical nephroureterectomy with regional lymphadenectomy and/or radiation therapy in cases where a pronounced tendency of down-growth invasion is suspected.