Partial nephrectomy in high-risk urothelial cancer of the calyx
Summary. Introduction. Upper urinary tract cancer (UTUC) amounts approximately 10% of all cases among kidney lesions and 5% of all urothelial cancers. Limited clinical sympotms often lead to late stage diagnosis. Around 60-80% of all cases are invasive and multifocal at primary examination. Radical nephroureteretomy remains the standart of care although it leads to kidney function decrease. Renal function loss often limits the use of systemic therapy in this patients thus decreasing oncological outcomes. Anatomical location of urothelial carcinomas in kidney calyx is known to be the most surgically complex. Organ-sparing treatment in this area among patients with high-risk urothelial carcinomas of the upper urinary tract is limited to clinical cases or small retrospective studies in the literature. Functional and oncological outcomes of such approach remain unclear. The aim of our study was to estimate oncological and functional outcomes of partial nephrectomy in patients with high-risk urothelial carcinomas of the renal calyx. Materials and methods. Retrospective data base analysis of 125 patients with UTUC that underwent surgical treatment in National Cancer Institute. The group of 10 patients with high-risk calyx tumors which underwent organ-sparing approach was selected for further analysis. All patients underwent complex examination that included CT or MRI, cystoscopy with uretheroscopic biopsy, urine cytology and dynamic scintigraphy. Locally advanced cases were excluded at basic data evaluation. Statistical analysis was done using exact Fischer’s test taking to account low group volume. Results. Observational period varied from 3 to 107 months with an average of 35. Average age — 59 years. 4 patients had positive urine cytology. Tumor size ranged from 2,3 to 6,6 cm (average 4,3 cm). Average surgical time — 238±36 min (186–269). Average blood loss — 400 ml (150–850 ml). Duration of postoperative stay was 6,3±1,8 days (3–9 days). Four of 9 patients had Clavien — Dindo complications rate 1–2. Affected kidney function one year after surgery estimated 17 ml/min in average. Exact Fischer’s test didn’t reveal any dependence between remaining functioning parenchyma volume and unilateral kidney function (p =0,173) or postoperative creatinine level (p = 0,163). 1/10 (10%) patient died due disease progression during observational period. 2/10 (20%) patient had bladder recurrence that was succesfully managed endoscopically. 7/10 cases underwent full dose platinum-based chemotherapy with no dose reduction. Exact Fischer’s test didn’t reveal any dependence between recurrence rate and tumor size (р= 0,932) or pathologic stage (p = 1,0). Conclusion. Partial nephrectomy is an option for management of high-risk upper urinary tract cancer. It provides functional benefit thus creating a chance for effective systemic therapy.
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