Long-term Outcomes of Immediate Versus Delayed Nephroureterectomy for Upper Tract Urothelial Carcinoma
dc.contributor.author | Gadzinski, Adam J. | en_US |
dc.contributor.author | Roberts, William W. | en_US |
dc.contributor.author | Faerber, Gary J. | en_US |
dc.contributor.author | Wolf, J. Stuart, Jr. | en_US |
dc.date.accessioned | 2012-03-22T17:23:10Z | |
dc.date.available | 2012-03-22T17:23:10Z | |
dc.date.issued | 2011-08-31 | en_US |
dc.identifier.citation | Gadzinski, Adam J.; Roberts, William W.; Faerber, Gary J.; Wolf, J. Stuart (2011). "Long-term Outcomes of Immediate Versus Delayed Nephroureterectomy for Upper Tract Urothelial Carcinoma." Journal of Endourology. <http://hdl.handle.net/2027.42/90447> | en_US |
dc.identifier.issn | 0892-7790 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/90447 | |
dc.description.abstract | Purpose: To compare immediate nephroureterectomy with delayed nephroureterectomy after a trial of nephron-sparing endoscopic surgery in patients who were treated initially at our institution from 1996 to 2004 for upper tract urothelial carcinoma. Patients were monitored for upper tract recurrences, metastases, cancer-specific and overall survival. Survival outcomes and perioperative measurements were compared between treatment groups. Results: Of 73 patients, 62 underwent immediate nephroureterectomy and 11 proceeded to nephroureterectomy after failed endoscopic management. Mean follow-up for all patients was 58 months and 75 months for patients who were alive at last follow-up. Patients treated initially with endoscopy averaged a surveillance procedure every 3.7 months and had a median delay to nephroureterectomy of 10 months. Perioperative measurements at time of nephroureterectomy did not differ between groups. Overall survival 5 years from initial resection in the delayed group and from nephroureterectomy in the immediate group was 64% and 59%, respectively; the corresponding 5-year cancer-specific and metastasis-free survival estimates were 91% vs 80% and 77% vs 73%, respectively (P>0.05). Pathologic progression from low to high-grade occurred in three of seven patients from the delayed group. Conclusions: Failure of endoscopic management necessitating nephroureterectomy does not appear to affect survival outcomes compared with immediate nephroureterectomy in patients with upper tract urothelial carcinoma. A trial of endoscopic management can be considered in patients with low-grade disease and a normal contralateral kidney. Endoscopy is a viable option when there are imperative indications for nephron sparing in the setting of high-grade disease. | en_US |
dc.publisher | Mary Ann Liebert, Inc., publishers | en_US |
dc.title | Long-term Outcomes of Immediate Versus Delayed Nephroureterectomy for Upper Tract Urothelial Carcinoma | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.identifier.pmid | 21879886 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/90447/1/end-2E2011-2E0220.pdf | |
dc.identifier.doi | 10.1089/end.2011.0220 | en_US |
dc.identifier.source | Journal of Endourology | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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