Login to Access Video or Poster Abstract: MP78-16
Sources of Funding: None

Introduction

Upper tract urothelial carcinoma (UTUC) is an uncommon malignancy, accounting for only five percent of urothelial cancers. Traditionally, nephroureterectomy (NU) with removal of an ipsilateral bladder cuff has been the standard for treatment of this disease entity. However, less invasive, kidney-sparing techniques are becoming more widely embraced. The use of ureteroscopy for the management of UTUC has been advocated in select circumstances such as in patients with a solitary kidney or bilateral disease. Based on our multiple decade experience with this technique, however, we champion a more robust role for this technique and present here our patient experience and outcomes with the use of endoscopy in the management of UTUC.

Methods

An extensive retrospective review was performed of over two hundred patients with UTUC initially managed by a single endourologic surgeon. Patients were seen over a 21 year period from 1994-2015 with initial evaluations occurring from 1994-2008.Evaluations were performed on patient and tumor characteristics as well as surgical parameters. Statistical analyses were utilized to determine factors affecting patient outcomes.

Results

A total of 258 patients diagnosed with UTUC were initially evaluated and managed by a single surgeon. 1486 procedures were performed with mean of 7.0 procedures per patient over the period of evaluation. Average tumor size on initial ureteroscopic excision was 16.8 mm (range 1-60) while average recurrent tumor size was 6.4 mm (range 1-50). Of this patient cohort, 94.2% were white and 66% were male. Patients with low grade tumors were successfully managed long-term, with 70.6% of patients avoiding NU. Even in cases of patients with high tumor volume, ureteroscopic management was associated with relatively long-term patient survival. Seventy patients ultimately underwent NU for reasons including conversion to high grade, tumor burden, patient choice and difficult endoscopic access. Multivariate analysis revealed no association of tumor location with survival. Patients with at least a 5 year follow up had overall survival 46.3% and recurrence free survival (RFS) 22%. In this subpopulation, patients with initial grade 1 tumors had RFS of 37.8%. Their average follow up was 7.1 years (range 5-20).

Conclusions

We have demonstrated that ureteroscopic management of UTUC is a successful alternative to NU for patients with low grade tumors. This work presents a comprehensive investigation of tumor characteristics as well as patient outcomes over a twenty one year period of management of patients with UTUC by a single initial surgeon.

Funding

None