Local excision of urothelial cancer of the upper urinary tract

Results of conservative treatment of upper urinary tract transitional cell carcinoma

BACKGROUND

The treatment preserving the kidney for upper urinary tract tumor is still controversial. The indications and results of conservative treatment remain to be elucidated. Experiences of this type of treatment are reported.

METHODS

Between April 1981 and March 1998, 14 patients with upper urinary tract transitional cell carcinoma were treated with renal preserving methods. Five were elective and nine were imperative cases. Treatments performed were partial nephrectomy, partial ureterctomy with or without adjuvant chemotherapy, endoscopic tumor resection and topical bacillus Calmette-Guerin instillation in one, 10, two and one patient, respectively.

RESULTS

Crude and cause-specific 5 year-survival rates were 91.7 and 100%, respectively. Of 14 patients, five had bladder recurrences, but ipsilateral local recurrence developed in only one patient. Two patients died from metastasis of transitional cell carcinoma 61 and 89 months after initial treatment. The lesions of carcinoma in situ were well controlled with topical bacillus Calmette-Guerin therapy.

CONCLUSION

The results of conservative treatment for upper urinary tract tumor were satisfactory and local excision can be indicated for low grade, solitary tumors located in the distal ureter.

Pyelo-intestino-cutaneous conduit in the treatment of renal carcinoma of solitary kidneys

A pyelo-intestino-cutaneous conduit, either by colonic or ileal segment, was used successfully in 4 patients with urothelial carcinoma affecting a solitary kidney. Primary healing was good but involved the risk of stricture formation. During the follow-up period (10-48 months), repeated endoscopic check-ups were easily performed through the conduit, enabling coagulation of recurrent tumour growth. Two patients are still alive and well; 2 are dead.

Urothelial tumours of the upper urinary tract

We present a retrospective 10 year analysis of 76 patients with urothelial tumours of the upper urinary tract. Patients older than 65 years, and female patients, presented with more advanced stages and had a worse prognosis. The grade and stage of the tumour has the greatest impact on survival. No conclusions can be drawn on the efficacy of various types of surgery, but simple nephrectomy gave a 5-year survival of 68%, with a stump recurrence rate of 15%. We observed that patients with urothelial tumours had 4 fold increased chance of developing gastrointestinal cancer.