European urology · 1996
Organ-sparing treatment for ureteral carcinoma?
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Leitenberger A, Beyer A, Altwein J E
Аннотация
OBJECTIVE: Nephroureterectomy (NUE) with a bladder cuff is the standard therapy for ureteral cancer. Based on an analysis of the literature and a retrospective study, this concept is questioned.
METHODS: Between 1980 and 1991, 40 patients with ureteral tumors underwent surgery at the Krankenhaus der Barmherzigen Brüder in Munich. Tumoral stages were pTa and pTl in 62% of the patients; 37% showed an invasive carcinoma. Radical surgery (NUE with bladder cuff) was performed in 22 patients and conservative treatment (ureterocystoneostomy or end-to-end-anastomosis) in 13 patients.
RESULTS: The median follow-up was 42 months in the conservative group and 59 months in the radical surgery group. A recurrence in the conservatively operated patients was observed only in primary invasive tumors (4/13), whereas none of the remaining patients had a recurrent tumor. In terms of time to progression and tumor-specific survival, there was a good correlation of the ureteral carcinoma according to grading and staging. In terms of survival, patients with superficial tumors run a similar course whether treated by conservative or radical surgery.
CONCLUSION: The conservative treatment of patients presenting with superficial ureteral lesions seems to be a good alternative to radical surgery.
METHODS: Between 1980 and 1991, 40 patients with ureteral tumors underwent surgery at the Krankenhaus der Barmherzigen Brüder in Munich. Tumoral stages were pTa and pTl in 62% of the patients; 37% showed an invasive carcinoma. Radical surgery (NUE with bladder cuff) was performed in 22 patients and conservative treatment (ureterocystoneostomy or end-to-end-anastomosis) in 13 patients.
RESULTS: The median follow-up was 42 months in the conservative group and 59 months in the radical surgery group. A recurrence in the conservatively operated patients was observed only in primary invasive tumors (4/13), whereas none of the remaining patients had a recurrent tumor. In terms of time to progression and tumor-specific survival, there was a good correlation of the ureteral carcinoma according to grading and staging. In terms of survival, patients with superficial tumors run a similar course whether treated by conservative or radical surgery.
CONCLUSION: The conservative treatment of patients presenting with superficial ureteral lesions seems to be a good alternative to radical surgery.