Radical nephroureterectomy (RNU) remains the standard of care for patients with upper tract urothelial carcinoma (UTUC). Segmental ureterectomy (SU) has gained traction, given its benefit of preserving renal function without compromising oncologic control, particularly in low-risk disease.
However, concerns persist regarding its oncological safety. We aimed to evaluate the oncologic and renal function outcomes in patients who underwent SU and RNU for UTUC. In August 2024, we systematically searched PubMed, Embase, Medline, and Cochrane databases to identify studies comparing oncologic outcomes and renal function preservation in patients who underwent SU and RNU for UTUC. Primary outcomes were cancer-specific survival (CSS), estimated glomerular filtration rate (eGFR) changes, and postoperative eGFR. Secondary outcomes included overall survival (OS), recurrence-free survival (RFS), and metastasis-free survival (MFS). Twenty-nine studies totaling 33,241 patients were included. No significant difference in 5-year CSS was observed between SU and RNU (HR 1.04, [95% confidence interval 0.93. 1.15], P = .49). A statistically significant higher 1-year postoperative eGFR (MD 17, [7.33, 26.67], P = .0006) and less pronounced eGFR change (MD 0.70, [0.24, 1.16], P = .003) were observed in the SU group. Additionally, the 5-year OS, RFS, and MFS were comparable between the groups. SU yielded comparable oncological outcomes to RNU concerning 5-year CSS, OS, RFS, and MFS while providing a higher postoperative eGFR and lower eGFR change at 1-year follow-up. SU might represent a viable treatment modality for UTUC in low-risk and carefully selected high-risk patients, although high-quality prospective trials implementing standardized outcome reporting are needed to draw definitive conclusions.
Urologic oncology. 2025 Jun 12 [Epub ahead of print]
Alejandro Calvillo-Ramirez, Lauren Chew, Laura Davis, Ana Paulina Casas-Huesca, Luis A Esparza-Miranda, Valeria Michelle Perez Alvarado, Jesse Sanchez Cardenas, Juan Carlos Angulo-Lozano, Hannia M Macias-Cruz, Luis Robles-Aquije, Gilberto Perez Rodriguez Garcia, Randy Vince
Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH. Electronic address: ., Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH., Facultad de Medicina, Universidad Autonoma de Guadalajara, Zapopan, Jalisco, Mexico., General Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico., General Medicine, Universidad Autonoma de Baja California, Ensenada, Baja California, Mexico., Department of Urology, Weill Cornell Medicine, New York, NY., Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico., General Medicine, Universidad San MartÃn de Porres, Lima, Peru., Department of Neurosurgery, University of Arizona, Phoenix, AZ.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40514292