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04.04.2016 | Topic Paper

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease

verfasst von: Georgios Gakis, Tina Schubert, Mehrdad Alemozaffar, Joaquim Bellmunt, Bernard H. Bochner, Steven A. Boorjian, Siamak Daneshmand, William C. Huang, Tsunenori Kondo, Badrinath R. Konety, Maria Pilar Laguna, Surena F. Matin, Arlene O. Siefker-Radtke, Shahrokh F. Shariat, Arnulf Stenzl

Erschienen in: World Journal of Urology | Ausgabe 3/2017

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Abstract

Purpose

To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d’Urologie for the treatment of localized high-risk upper tract urothelial carcinoma (UTUC).

Methods

A detailed analysis of the literature was conducted reporting on treatment modalities and outcomes in localized high-risk UTUC. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine modified by the ICUD.

Results

Radical nephroureterectomy (RNU) is the standard of treatment for high-grade or clinically infiltrating UTUC and includes the removal of the entire kidney, ureter and ipsilateral bladder cuff. The distal ureter can be managed either by extravesical or transvesical approach, whereas endoscopically assisted procedures are associated with decreased intravesical recurrence-free survival. Post-operative intravesical chemotherapy decreases the risk of subsequent bladder tumour recurrence. Regional lymph node dissection is of prognostic importance in infiltrative UTUC, but its extent has not been standardized. Renal-sparing surgery is an option for manageable, high-grade tumours of any part of the upper tract, especially of the distal ureter, as an alternative to RNU. Endoscopy-based renal-sparing procedures are associated with a higher risk of recurrence and progression.

Conclusions

A multimodal approach should be considered in localized high-risk UTUC to improve outcomes. RNU is the standard of treatment in high-risk disease. Renal-sparing approaches may be oncologically equivalent alternatives to RNU in well-selected patients, especially in those with distal ureteric tumours.

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Titel: Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease
verfasst von: Georgios Gakis
Tina Schubert
Mehrdad Alemozaffar
Joaquim Bellmunt
Bernard H. Bochner
Steven A. Boorjian
Siamak Daneshmand
William C. Huang
Tsunenori Kondo
Badrinath R. Konety
Maria Pilar Laguna
Surena F. Matin
Arlene O. Siefker-Radtke
Shahrokh F. Shariat
Arnulf Stenzl
Publikationsdatum: 04.04.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 3/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1819-1

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