Nandurkar Ruchira, Basto Marnique, Sengupta Shomik
Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia.
Department of Urology, Eastern Health, Melbourne, Victoria, Australia.
Transl Androl Urol. 2020 Dec;9(6):3160-3167. doi: 10.21037/tau.2019.11.27.
Upper tract urothelial carcinoma (UTUC) often occurs in elderly patients with multiple co-morbidities including renal impairment. As such, nephron sparing surgery (NSS) often needs to be considered. This article reviews the available NSS techniques for UTUC, including ureteroscopy, percutaneous approaches and segmental ureterectomy. PubMed and OvidMEDLINE reviews of available case series from the last 10 years demonstrated that recurrence was highly variable between studies and occurred in 19-90.5% of ureteroscopic cases, 29-98% of percutaneous resections and in 10.2-31.4% of patients who underwent segmental ureterectomy. The small number of included studies and variable follow up periods made comparison between techniques difficult. NSS is a necessary alternative for patients with significant comorbidities or renal impairment who cannot undergo radical nephro-ureterectomy. However, there is significant variation in oncological outcomes, with an increased risk of progression or death from cancer-salvage by radical surgery may sometimes be required.
上尿路尿路上皮癌（UTUC）常发生于患有多种合并症（包括肾功能损害）的老年患者。因此，通常需要考虑保留肾单位手术（NSS）。本文综述了适用于UTUC的NSS技术，包括输尿管镜检查、经皮入路和节段性输尿管切除术。对过去10年可用病例系列的PubMed和OvidMEDLINE综述表明，不同研究之间复发率差异很大，输尿管镜检查病例的复发率为19%至90.5%，经皮切除术的复发率为29%至98%，接受节段性输尿管切除术的患者复发率为10.2%至31.4%。纳入研究数量少且随访期不同使得不同技术之间难以比较。对于有严重合并症或肾功能损害而无法接受根治性肾输尿管切除术的患者，NSS是一种必要的替代方案。然而，肿瘤学结局存在显著差异，有时可能需要通过根治性手术来降低癌症挽救后进展或死亡的风险。
