Organ preserving and minimal invasive Surgery for Urothelial Cancer of upper Urinary Tract

Ch. Lang, Academic Teaching Hospital of Saar University, Germany

Introduction:
Urothelial carcinomais apanendotheliale disease, with appearance inlower and upper urinary tract (uUT). Urothelial carcinomas of the uUT account for 5–10% of Urothelial Cancers.
Whereas in renal cell cancer meanwhile kidney sparing surgery is the common standard of care if ever possible, organ preserving strategies in urothelial carcinoma of uUT are challenging the previous rules. Nevertheless, in national and international guidelines meanwhile nephron sparing surgery is implemented by respecting the risk characteristics of these tumours. Surgical procedures get more and more standardised and instruments like flexible scopes and laser systems are introduced for treatment option.

Methode:
Based on cases of my department surgical options in kidney sparing surgery using open and endoscopic approach are demonstrated: partial Nephrectomy, partial Ureterectomy and Retrograde Intrarenal Surgery (RIRS) using flexible Scopes and Thulium Laser.

Conclusions:

  • Treatment paradigm has changed from radical access toorgan preserving Management in Urothelial Cancer of uUT.
  • Outcome data depends on favourable tumour characteristics and patient co-morbidities, but seems to be equivalent concerning oncological result.
  • Carefully selected cases of my department are able to benefit from kidney preserving strategies – high risk patients showunfavourable outcome.
  • Endoscopic instruments, Lasers and their handling are established and save in practice.
  • Nephron Sparing Surgery comes intofirst line treatment in selected patients with low risk.