An Audit Of Nephroureterectomy For Upper Tract Urothelial Carcinoma

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 26 Oct 2009 - 3:00 PDT

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UroToday.com - In our recently published study, we presented data on a large series of patients with primary upper tract urothelial carcinoma and evaluated the necessity of concomitant adrenalectomy. The analysis showed in certain cases, nephroureterectomy might exclude adrenalectomy.

Increasing evidence suggests the importance of regional lymph node dissection, which implies that the extent of surgery be expanded to improve long-term cancer survival. However, the role of adrenalectomy has not been well studied. Presently, based on the concept of evidence-based medicine, there is limited study to confirm the significance of adrenalectomy though most urologists do not perform this procedure during nephroureterectomy.

Through this retrospective analysis for a Taiwanese patient cohort, the authors concluded adrenal-sparing nephroureterectomy is justified. We are going to initiate a prospective study to investigate whether the survival benefit will be achieved by routinely performing adrenalectomy during the operation, and try to confirm the findings we have based on the retrospective study. As we know, simultaneous adrenalectomy is appropriate for advanced or upper pole renal cell carcinoma but could be omitted in selected patients such as those with low pole and localized tumors. We also need be concerned about postoperative impaired renal function, which will negatively influence overall morbidity and mortality. Multiple reports have demonstrated that in selected patients, cancer control is not undermined by partial nephrectomy compared to radical nephrectomy for renal cell carcinoma patients. However, while partial nephrectomy is not appropriate for upper tract urothelial carcinoma, we believe preservation of renal function might be achieved in selected upper tract urothelial carcinomas and therefore warrants more well-designed clinical study to establish this concept.

Another issue is the role of prophylactic intravesical chemotherapy to reduce the occurrence rate of subsequent bladder urothelial carcinoma, which will also be studied in this same prospective setting.

Written by Shiu-Dong Chung, MD as part of Beyond the Abstract on UroToday.com.

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