SIU 2017: Kidney Resection in Patients with Urothelial Cancer

Lisbon, Portugal ( Partial nephrectomy in patients with urothelial tumors is a rare type of surgery and can be performed only in cases of localized small tumors of the calyx when renal function is preserved. The aim of his study was to evaluate short and long term functional and oncological outcomes of patients who underwent partial nephrectomy due to urothelial carcinoma.

Retrospective analysis of 87 patients with upper urinary tract cancers that were treated in our department from 2008 to 2017 was performed. Average age was 66.3 + 5.4 years. Men\women ratio was 68 (78 %) / 19 (22%). Conservative radical nephroureterectomy was conducted in 24 (27.5%) cases, and 6 patients (6.8%) underwent partial nephrectomy and became the object of our study.

Average observation period was 28.4 + 18.2 months. All patients had localized tumors with lesion area that did not exceed 50% of pelvi-calyceal system. Tumors were located in the lower segment calyces in 3 patients, in middle segment – in 1 patient and in upper segment - in 2 patients. According to dynamic renal scintigraphy average unilateral kidney GFR prior to surgery was 19.6 + 5.2 ml/min, serum creatinine level - 1.16 + 0.26 mg\dl. All patients underwent resection of the affected calyx with the segment were it was located. In cases of upper pole resection renal cavities were sutured, but when tumor was located in the middle or lower segment, a reconstruction of the pelvi-calyceal system was performed. All Surgical procedures were conducted without ischemia. Average blood loss was 564 + 178 ml. There were no early surgical complications. According to dynamic renal scintigraphy average unilateral kidney GFR 3 months after surgery was 15.8 + 4.8ml\min, postoperative serum creatinine level was - 1.21 + 0.21 mg\dl. There were no local relapses in the follow-up period. 

The authors concluded that although partial nephrectomy in patients with pelvi-calyceal urothelial tumors is a complex surgical procedure, it preserves unilateral and total glomerular filtration rate. Early diagnosed urothelial tumors of the upper urinary tract can be treated with partial nephrectomy, and favorably affect the functional outcomes of the affected kidney.

Presented by: Maksym Pikul
Affiliation:  National Cancer Institute of Ukraine, Kyiv, Ukraine

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal