Purpose: To review the latest evidence on the modern techniques and outcomes of kidney-sparing surgeries (KSS) in patients with upper tract urothelial carcinoma (UTUC). Methods: A comprehensive literature search on the study topic was conducted before 30 April 2023 using electronic databases including PubMed, MEDLINE, and EMBASE. A narrative overview of the literature was then provided based on the extracted data and a qualitative synthesis of the findings. Results: KSS is recommended for low- as well as select high-risk UTUCs who are not eligible for radical treatments. Endoscopic ablation is a KSS option that is associated with similar oncological outcomes compared with radical treatments while preserving renal function in well-selected patients. The other option in this setting is distal ureterectomy, which has the advantage of providing a definitive pathological stage and grade. Data from retrospective studies support the superiority of this approach over radical treatment with similar oncological outcomes, albeit in select cases. Novel chemoablation agents have also been studied in the past few years, of which mitomycin gel has received FDA approval for use in low-risk UTUCs. Conclusion: KSSs are acceptable approaches for patients with low- and select high-risk UTUCs, which preserve renal function without compromising the oncological outcomes.
目的：综述上尿路尿路上皮癌患者保留肾脏手术的现代技术与疗效的最新证据。方法：于2023年4月30日前通过PubMed、MEDLINE和EMBASE等电子数据库对研究主题进行全面文献检索，基于提取数据对文献进行叙述性概述，并对研究结果进行定性整合。结果：对于不适合根治性治疗的低危及经筛选的高危上尿路尿路上皮癌患者，推荐采用保留肾脏手术。内镜消融术作为保留肾脏手术的一种选择，在严格筛选的患者中既能保留肾功能，其肿瘤学结果也与根治性治疗相当。另一种术式为远端输尿管切除术，其优势在于能提供明确的病理分期和分级。回顾性研究数据表明，在特定病例中该术式在肿瘤学结果相当的前提下优于根治性治疗。近年来新型化学消融剂也得到研究，其中丝裂霉素凝胶已获美国食品药品监督管理局批准用于低危上尿路尿路上皮癌的治疗。结论：对于低危及经筛选的高危上尿路尿路上皮癌患者，保留肾脏手术在维持肾功能的同时不影响肿瘤学结果，是可接受的治疗方案。
Modern Kidney-Sparing Management of Upper Tract Urothelial Carcinoma
肿瘤(癌症)患者之家