Objective: To evaluate the clinical safety and efficacy of kidney-sparing surgery to treat the primary transitional cell carcinoma of ureter.
Methods: The materials of 29 cases which underwent kidney-sparing surgery for treatment of the carcinoma of ureter were analyzed retrospectively. All the patients underwent kidney-sparing surgeries: 3 cases for endoscopy ablation, 8 cases for laparoscopy (5 direct ureterocystoneostomies, 3 reimplantations on Boari flap bladder), 18 cases for open surgeries (10 direct ureterocystoneostomies, 5 reimplantations on Boari flap bladder, and 3 end-to-end anastomoses). All the patients underwent regular intravesical instillation and close follow-up post-operation, 3 cases also received intravenous chemotherapy.
Results: All the pathology was transitional cell carcinoma, including 4-papillary urothelial neoplasms of low malignant potential, 13 low-grade papillary urothelial carcinoma, and 12 high-grade papillary urothelial carcinoma. Clinical stage was classified T1 (5), T2 (18) and T3 (6). The recurrence in bladder and ipsilateral ureter was 10.3% and 3.4%, respectively. Two cases suffered from urine leak, 5 cases had mild hydronephrosis, and 3 cases died of heart and lung diseases. The recurrence in bladder was 5.9% in low-grade tumors, and the recurrence in bladder and ipsilateral ureter was 11.1% in T2 tumors, 33.3% in T3 tumors.
Conclusions: Kidney-sparing surgery is a feasible treatment option for the selected patients with unifocal middle or distal ureteric carcinoma at low grade or without invasive aspect on CT. Laparoscopic ureterocystoneostomy or endoscopic management had more minimally invasive advantages in the treatment. However, active surveillance should be done during the follow-up.
