A prognostic study of urothelial renal pelvic tumors: comparison between the prognosis of patients treated with intrafascial nephrectomy and perifascial nephroureterectomy.

A comparison of the prognosis between 2 series of patients with urothelial renal pelvic tumors is presented. One series comprising 70 patients was operated with intrafascial nephrectomy with extirpation of varying length of the ureter. The other series comprising 38 patients was operated with transabdominal perifascial nephrectomy with homolateral adrenalectomy, total ureterectomy and in 28 patients retroperitoneal lymphadenectomy. The 5-year survival was 51% in the patients operated with intrafascial nephrectomy and 84% in the patients operated with perifascial nephrectomy. The difference in prognosis is statistically significant (p less than or equal to 0.01) and cannot be explained by differences in extent of tumor infiltration, tumor grade or tumor size. The main difference in prognosis between the two series was in patients with high stage tumors (Grabstald stage 3 and 4). The 5-year survival was 74% in patients with stage 3 and 4 tumors in the patients operated with perifascial nephrectomy compared with 37% in the patients operated with intrafascial nephrectomy. Since it is not possible with absolute certainty to determine tumor stage before the operation, an aggressive attitude against urothelial renal pelvic tumors is recommended. Thus the patients should undergo transabdominal perifascial nephroureterectomy including a cuff of the bladder wall and homolateral adrenalectomy. In patient with bilateral tumors, renal insufficiency of tumor in a single kidney parenchyma saving partial resection must be performed.