Organ-sparing treatment for ureteral carcinoma?

Abstract

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. 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. 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. The conservative treatment of patients presenting with superficial ureteral lesions seems to be a good alternative to radical surgery.