Presentation Authors: Asaf Shvero*, Dorit Zilberman, Menahem Laufer, Yasmin Abu-Ghanem, Zohar A. Dotan, Eddie Fridman, Orith Portnoy, Jacob Ramon, Harry Winkler, Nir Kleinmann, Ramat Gan, Israel
Introduction: Radical Nephroureterectomy (RNU) is considered the gold standard treatment for upper tract urothelial carcinoma (UTUC) larger than 2 cm. The purpose of this study was to examine surgical and oncological outcome of ureteroscopic (URS) treatment for UTUC larger than 2cm and compare them to outcome of tumors smaller than 2cm.
Methods: Medical records were reviewed for all patients undergoing URS for UTUC at our institution from January 2013 to August 2018. Tumor size was determined by pre-operative CT-Urography or retrograde pyelography during URS. Tumors were biopsied using a flat-wire basket and treated using a dual laser generator: Neodymium (Nd:YAG) for tumor coagulation and Holmium (Ho:YAG) for tumor resection. Follow-up protocol included URS every 3 months during the first year after initial treatment, every 6 months in the 2nd year, and annually thereafter. Demographic data and tumor characteristics were obtained for all patients. patientsâ€™ courses were reviewed for tumor recurrence, grade progression and development of locally advanced or metastatic disease. Outcome of patients with tumor equal or larger than 2cm were compared to those of patients with tumor smaller than 2cm.
Results: During this period of time, 343 ureteroscopies (URS) were performed on 87 patients. Patients with High-grade disease on pathology, and patients with follow-up of 3 months or shorter were excluded. The cohort included 37 patients, 20 men, at a median age of 70 years. 13 patients had a tumor equal or larger than 2cm, while 24 had a tumor smaller than 2 cm. Median tumor size was 30mm (range 20-40mm) and 10 mm (1-17mm) with a mean of 5.2 and 5.6 URS per patient (2-11) in the large and small-tumor groups, respectively. In the large-tumor group median follow-up time was 16 months (3-40), local recurrence rate was 46% after a mean of 4.9 months post URS and a mean recurrence size of 5.5mm. In the small-tumor group median follow-up time was 20 months (4-60), local recurrence rate was 71%, after a mean of 9.9 months post URS and a mean recurrence size of 5.8mm. No difference was found in local recurrence rate (p < 0.553), of bladder tumor occurrence (p < 0.253) between the groups. One patient in the large-tumor group developed high-grade disease and was referred to RNU after 12 months of ureteroscopic management. None of the patients in the cohort developed metastatic progression during the follow-up period.
Conclusions: Ureteroscopic treatment of large upper tract urothelial carcinoma has good short-term oncologic outcome. Tumors larger than 2 cm tend to locally recur faster. Strict ureteroscopic surveillance might be considered for these cases.