Ghoreifi Alireza, Sari Motlagh Reza, Fuchs Gerhard
Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA.
Urology Department, University of Vienna, 1090 Vienna, Austria.
Cancers (Basel). 2023 Sep 10;15(18):4495. doi: 10.3390/cancers15184495.
To review the latest evidence on the modern techniques and outcomes of kidney-sparing surgeries (KSS) in patients with upper tract urothelial carcinoma (UTUC).
A comprehensive literature search on the study topic was conducted before 30 April 2023 using electronic databases including PubMed, MEDLINE, and EMBASE. A narrative overview of the literature was then provided based on the extracted data and a qualitative synthesis of the findings.
KSS is recommended for low- as well as select high-risk UTUCs who are not eligible for radical treatments. Endoscopic ablation is a KSS option that is associated with similar oncological outcomes compared with radical treatments while preserving renal function in well-selected patients. The other option in this setting is distal ureterectomy, which has the advantage of providing a definitive pathological stage and grade. Data from retrospective studies support the superiority of this approach over radical treatment with similar oncological outcomes, albeit in select cases. Novel chemoablation agents have also been studied in the past few years, of which mitomycin gel has received FDA approval for use in low-risk UTUCs.
KSSs are acceptable approaches for patients with low- and select high-risk UTUCs, which preserve renal function without compromising the oncological outcomes.
回顾上尿路尿路上皮癌（UTUC）患者保留肾手术（KSS）的现代技术和结果的最新证据。
在2023年4月30日前，使用包括PubMed、MEDLINE和EMBASE在内的电子数据库，对该研究主题进行了全面的文献检索。然后根据提取的数据对文献进行叙述性综述，并对研究结果进行定性综合分析。
对于不适合根治性治疗的低风险以及部分高风险UTUC患者，推荐采用KSS。内镜消融是一种KSS选择，与根治性治疗相比，在精心挑选的患者中保留肾功能的同时，具有相似的肿瘤学结果。在这种情况下的另一种选择是远端输尿管切除术，其优点是能提供明确的病理分期和分级。回顾性研究数据支持这种方法在肿瘤学结果相似的情况下优于根治性治疗，尽管是在特定病例中。在过去几年中也对新型化学消融剂进行了研究，其中丝裂霉素凝胶已获得美国食品药品监督管理局（FDA）批准用于低风险UTUC。
KSS是低风险以及部分高风险UTUC患者可接受的治疗方法，可保留肾功能且不影响肿瘤学结果。
