Abstract
Radical nephroureterectomy (RNU) represents the standard of care for high-risk upper
tract urothelial carcinoma (UTUC). In selected patients with ureteral UTUC, a conservative
approach such as segmental ureterectomy (SU) can be considered. However, this therapeutic
option remains controversial. The aim of this study was to perform a systematic review
and meta-analysis of studies assessing the outcomes of SU versus RNU in patients with
UTUC. Three search engines (Scopus, Embase, and Web of Science) were queried up to
May 2019. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement
(PRISMA Statement) was used as a guideline for study selection. The clinical question
was established as stated in the PICO (Population, Intervention, Comparator, Outcome)
process. Patients in the SU group were more likely to have history of bladder cancer
(odds ratio [OR], 1.99; 95% confidence interval [CI], 1.12-3.51; P = .02), but less likely to present with preoperative hydronephrosis (OR, 0.52; 95%
CI: 0.31-0.88; P = .02). A higher rate of ureteral tumor location was found in the SU group (OR, 7.54;
95% CI, 4.15-13.68; P < .00001). The SU group presented with a lower rate of higher (pT ≥ 2) stage (OR,
0.66; 95% CI, 0.53-0.82; P = .0002), and high-grade tumors (OR, 0.62; 95% CI, 0.50-0.78; P < .0001). The SU group was found to have shorter 5-year relapse-free survival (OR,
0.64; 95% CI, 0.43-0.95; P = .03), but higher postoperative estimated glomular filtration rate (weighted mean
difference, 10.97 mL/min; 95% CI, 2.97-18.98; P = .007). Selected patients might benefit from SU as a therapeutic option for UTUC.
In advanced high-risk disease, RNU still remains the standard of care.
Keywords
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Article info
Publication history
Published online: October 16, 2019
Accepted:
October 6,
2019
Received in revised form:
October 5,
2019
Received:
August 15,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
