Schuil Hugo W, Figaroa Orlane J A, Baard Joyce, Lifshitz David A, Jamaludin Faridi S, Kamphuis Guido M
Department of Urology, Amsterdam UMC, University of Amsterdam.
Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
Curr Opin Urol. 2025 Jan 1;35(1):58-67. doi: 10.1097/MOU.0000000000001248. Epub 2024 Nov 7.
This review provides an overview of the recent publications on kidney-sparing-surgery (KSS) for upper tract urothelial carcinoma (UTUC), an alternative to radical nephroureterectomy (RNU) for an increasing number of indications.
Recent studies highlight comparable survival outcomes between KSS [ureterorenoscopy with tumour ablation (URS) or segmental ureteral resection (SUR)] and RNU, even in high-risk UTUC patients. KSS has shown to preserve renal function without significantly compromising oncologic control in appropriately selected patients. Included literature also researched surgical complications, surveillance strategies, such as second-look ureteroscopy, and comparative cost analyses.
Over the past two and a half years, studies have emphasized the growing usage of URS and SUR in treating selected UTUC patients. Recent literature has remarkably included relatively large numbers of typically high-risk patients with features such as high-grade tumours, stage >Ta, multifocality, and hydronephrosis with acceptable results. Further research should expand on the different indications for KSS, its postoperative surveillance and comparative economic analyses.
本综述概述了近期关于上尿路尿路上皮癌（UTUC）保留肾手术（KSS）的出版物，KSS作为根治性肾输尿管切除术（RNU）的替代方案，适用于越来越多的适应症。
近期研究强调了KSS[输尿管镜肿瘤消融术（URS）或节段性输尿管切除术（SUR）]与RNU之间具有可比的生存结果，即使在高危UTUC患者中也是如此。在适当选择的患者中，KSS已显示出可保留肾功能，而不会显著影响肿瘤控制。纳入的文献还研究了手术并发症、监测策略，如二次输尿管镜检查，以及成本比较分析。
在过去两年半中，研究强调了URS和SUR在治疗特定UTUC患者中的使用越来越多。近期文献显著纳入了相对大量具有典型高危特征的患者，如高级别肿瘤、分期>Ta、多灶性和肾积水，结果可接受。进一步的研究应扩展KSS的不同适应症、术后监测和成本比较分析。
