Clinical efficacy of partial ureterectomy in patients with invasive carcinomas of the upper urinary tract
Pikul M.V. , Stakhovskyi E.O., Voylenko O.A. , Stakhovsky O.E. , Vitruk Iu., Kononenko O.A., Semko S.L., Grechko B.O. , Koshel D.O. , Karkych O.
Summary. Introduction. Upper urinary tract carcinoma features and the frequent onset of the disease with existing chronic kidney disease create a paradigm for preservation of the level of glomerular filtration which could be extremely important. The risk of recurrence depends more on ttumor agressiveness, rather than on the chosen type of surgical intervention. Accordingly, patients with more aggressive tumors will be more likely to require systemic therapy, which is often limited by the level of glomerular filtration after radical nephrureterectomy. Materials and methods. Taking to account the purpose and objectives of scientific work, patients were divided into 2 groups: patients with carcinoma of urerter undergoing organ-sparing treatment (main group) and radical nephroureterectomy (control group). The primary objectives of this analysis were to assess the safety profile of both types of surgical approaches, which included determining the duration of surgery, intraoperative hemorrhage, the level of postoperative complications according to the evaluation system — Clavien-Dindo, the duration of postoperative inpatient treatment. The secondary objectives of the study were to assess long-term functional outcomes (total glomerular filtration rate, serum creatinine levels after 3 months from time of surgery) and oncological outcomes (recurrence-free, progressive, cancer-specific, and overall survival levels) of both groups. Results. With statistically comparable indicators of total glomerular filtration before surgery (p=0.09), results obtained after surgery were better in partial ureterectomy group (p=0.002). It is important to note that this fwas most likely due to the preserved kidney on the affected side (19.3 + 4.9 ml/min). Therefore, organ-preserving treatment allowed to keep the total glomerular filtration above 60 ml/min, which fundamentally affected the likelihood of effective systemic therapy in the postoperative period. Another important point is the positive effect of this level of renal function on reducing the likelihood of cardiovascular events. (groups were identical by the number of recurrences in the urinary tract). Thus, organ-sparing treatment did not statistically significantly increase the risk of recurrence in the urinary system (log-rank test; p=0.55). The analysis of overall two-year survival also showed no statistical difference between surgical groups (log-rank test; p=0.62). Conclusions. Partial ureterectomy in high-risk urothelial carcinomas of the upper urinary tract is a safe surgical intervention in terms of perioperative complications compared with RNUE. Organ-sparing treatment in these patients reliably leads to the preservation of renal function on the affected side and saving the level of total glomerular filtration above 60 ml/min. The level of local control in the urinary system is comparable in both surgical approaches, which does not worsen the final cancer outcome.
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