Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes
Autor: | H. Barton Grossman, Colin P.N. Dinney, E. Jason Abel, Surena F. Matin, Mark B. Fisher, Ashish M. Kamat |
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Jazyk: | angličtina |
Rok vydání: | 2013 |
Předmět: |
Adult
Male Pathologic Processes medicine.medical_specialty Time Factors Ureterectomy Urology Cystectomy lcsh:RC870-923 Nephrectomy Outcome Assessment (Health Care) Ureter Risk Factors medicine Atypia Humans Ureteral segment Aged Neoplasm Staging Urothelial carcinoma Aged 80 and over Carcinoma Transitional Cell Ureteral Neoplasms business.industry Middle Aged medicine.disease lcsh:Diseases of the genitourinary system. Urology Surgery medicine.anatomical_structure Upper tract Dysplasia Female Neoplasm Grading Neoplasm Recurrence Local business Renal pelvis |
Zdroj: | International Brazilian Journal of Urology, Vol 39, Iss 6, Pp 817-822 (2013) International braz j urol, Volume: 39, Issue: 6, Pages: 817-822, Published: DEC 2013 International braz j urol v.39 n.6 2013 International Braz J Urol Sociedade Brasileira de Urologia (SBU) instacron:SBU |
ISSN: | 1677-6119 |
Popis: | Objectives To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. Materials and Methods After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. Results From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years). Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66). At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%), all with initial grade 3 renal pelvis lesions, developed metastatic disease. Conclusions Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks. |
Databáze: | OpenAIRE |
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