Urological Science (Mar 2024)

Segmental ureterectomy outcome of upper tract urothelial carcinoma in a high endemic area: A Taiwan nationwide collaborative study

  • Shih‑Gang Wang,
  • Hao‑Lun Luo,
  • Hung‑Jen Wang,
  • Wen‑Jeng Wu,
  • Wei‑Ming Li,
  • Po‑Hung Lin,
  • See‑Tong Pang,
  • Shian‑Shiang Wang,
  • Jian‑Ri Li,
  • Han‑Yu Weng,
  • Ta‑Yao Tai,
  • Jen‑Shu Tseng,
  • Wun‑Rong Lin,
  • I‑Hsuan Alan Chen,
  • Jen‑Tai Lin,
  • Yuan‑Hong Jiang,
  • Yu‑Khun Lee,
  • Jen Kai Fang,
  • Chao‑Yuan Huang,
  • Wen‑Hsin Tseng,
  • Wei Yu Lin,
  • Chia‑Chang Wu,
  • Shu‑Yu Wu,
  • Pai‑Yu Cheng,
  • Po‑Han Lin,
  • Yung‑Tai Chen,
  • Allen W. Chiu,
  • Bing-Juin Chiang,
  • Chao-Hsiang Chang,
  • Chao-Yuan Huang,
  • Cheng-Huang Shen,
  • Cheng-Kuang Yang,
  • Cheng-Ling Lee,
  • Chen-Hsun Ho,
  • Che-Wei Chang,
  • Chia-Chang Wu,
  • Chieh-Chun Liao,
  • Chien-Hui Ou,
  • Chih-Chen Hsu,
  • Chih-Chin Yu,
  • Chih-Hung Lin,
  • Chih-Ming Lu,
  • Chih-Yin Yeh,
  • Ching-Chia Li,
  • Chi-Ping Huang,
  • Chi-Rei Yang,
  • Chi-Wen Lo,
  • Chuan-Shu Chen,
  • Chung-Hsin Chen,
  • Chung-You Tsai,
  • Chung-Yu Lin,
  • Chun-Hou Liao,
  • Chun-Kai Hsu,
  • Fang-Yu Ku,
  • Hann-Chorng Kuo,
  • Han-Yu Weng,
  • Hao-Han Chang,
  • Hong-Chiang Chang,
  • Hsiao-Jen Chung,
  • Hsin-Chih Yeh,
  • Hsu-Che Huang,
  • Ian-Seng Cheong,
  • I-Hsuan Alan Chen,
  • Jen-Kai Fang,
  • Jen-Shu Tseng,
  • Jen-Tai Lin,
  • Jian-Hua Hong,
  • Jih-Sheng Chen,
  • Jungle Chi-Hsiang Wu,
  • Kai-Jie Yu,
  • Keng-Kok Tan,
  • Kuan-Hsun Huang,
  • Kun-Lin Hsieh,
  • Lian-Ching Yu,
  • Lun-Hsiang Yuan,
  • Hao-Lun Luo,
  • Marcelo Chen,
  • Min-Hsin Yang,
  • Pai-Yu Cheng,
  • Po-Hung Lin,
  • Richard Chen-Yu Wu,
  • See-Tong Pang,
  • Shin-Hong Chen,
  • Shin-Mei Wong,
  • Shiu-Dong Chung,
  • Shi-Wei Huang,
  • Shuo-Meng Wang,
  • Shu-Yu Wu,
  • Steven Kuan-Hua Huang,
  • Ta-Yao Tai,
  • Thomas Y. Hsueh,
  • Ting-En Tai,
  • Victor Chia-Hsiang Lin,
  • Wei-Chieh Chen,
  • Wei-Ming Li,
  • Wei-Yu Lin,
  • Wen-Hsin Tseng,
  • Wen-Jeng Wu,
  • Wun-Rong Lin,
  • Yao-Chou Tsai,
  • Yen-Chuan Ou,
  • Yeong-Chin Jou,
  • Yeong-Shiau Pu,
  • Yi-Chia Lin,
  • Yi-Hsuan Wu,
  • Yi-Huei Chang,
  • Yi-sheng Lin,
  • Yi-Sheng Tai,
  • Yu-Khun Lee,
  • Yuan-Hong Jiang,
  • Yu-Che Hsieh,
  • Yu-Chi Chen,
  • Yu-Ching Wen,
  • Yung-Tai Chen,
  • Zhe-Rui Yang

DOI
https://doi.org/10.1097/us9.0000000000000018
Journal volume & issue
Vol. 35, no. 1
pp. 42 – 50

Abstract

Read online

Purpose:. According to the National Comprehensive Cancer Network guidelines, segmental ureterectomy (SU) of upper tract urothelial carcinoma (UTUC) is a considerable option for selected mid- and distal ureteral urothelial carcinoma (UC). As a UTUC endemic area, Taiwan lacks treatment outcome analysis of SU. Materials and methods:. This study retrospectively reviewed the treatment outcomes of SU for clinically localized UTUCs. Patients with biopsy or washing cytology-confirmed UTUCs who underwent open, laparoscopic, or robot-assisted management with curative intent were retrospectively reviewed for the eligibility of analysis. Cox regression was applied for univariable and multivariable analyses. Results:. A total of 161 patients who underwent SU were reviewed and analyzed. The median follow-up period was 44.5 (interquartile range, 21.6–84.9) months. After SU, 56/161 (34.8%) patients were free of UTUCs after the follow-up, 25/161 (15.5%) patients had local recurrence, and 35/161 (21.7%) had lymph node or distant metastasis. Surgical margin involvement was a risk factor associated with worse cancer-specific survival. Higher bladder recurrence and local recurrence rates were observed with concurrent bladder UC. Lymphovascular invasion and previous radical nephroureterectomy (RNU) for UC were related to higher local recurrence rates. Patients with pathological T3/T4 stage and end-stage renal disease tended to have higher metastasis rates. For the management of local recurrence, 19 patients received salvage RNU and 25 patients had adjuvant chemotherapy. However, 26/161 (16.1%) patients died of UTUCs and 2/161 (1.2%) patients died of surgery-related complications. Conclusion:. SU provides acceptable oncological outcomes if the surgeons select candidates carefully. SU is not recommended if the patient has T3 or higher stage or comorbidity of end-stage renal disease. Concurrent bladder UC is a risk factor for worse bladder recurrence-free survival and local recurrence-free survival. Lymphovascular invasion and previous RNU for UC were related to higher local recurrence rates. After SU, periodic follow-up is mandatory because the local recurrence rate is higher than radical surgery.