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Segmental Ureterectomy Versus Radical Nephroureterectomy in Older Patients Treated for Upper Tract Urothelial Carcinoma.
- Source :
-
Clinical genitourinary cancer [Clin Genitourin Cancer] 2022 Aug; Vol. 20 (4), pp. 381-387. Date of Electronic Publication: 2022 Jan 13. - Publication Year :
- 2022
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Abstract
- Introduction: The world population is ageing and surgical procedures for older patients are associated with higher perioperative morbidity and mortality rates than in younger patients. Segmental ureterectomy (SU) has been proposed as an alternative to radical nephroureterectomy (RNU) for selected upper tract urothelial carcinomas (UTUC), to reduce post-operative morbidity, and preserve renal function. The aim of this study was to compare RNU and SU in terms of post-operative complications, functional outcomes, and overall survival (OS) in older patients treated for UTUC.<br />Materials and Methods: Data of patients aged 75 years or older and treated for UTUC were included. The primary outcome was to compare RNU versus SU according to post-operative complications, the estimated glomerular filtration rate (eGFR) variation, and OS. Complications were defined according to the Clavien-Dindo classification. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Un-adjusted OS curves were plotted using the Kaplan-Meier method.<br />Results: Overall, 177 patients (150 RNU and 27 SU) were eligible for the analysis. Pre- and post-operative characteristics were similar between the 2 groups. RNU patients showed higher incidence of post-operative complications (34.0% vs. 7.4%, P = .011). The mean post-operative serum creatinine was lower in SU patients in comparison with the RNU ones (1.23 vs. 1.69 mg/dL, P = .046), but no differences were found in terms of eGFR variation (P = .258). At 3 years of follow-up, the OS was comparable between the two surgical techniques (P = .129).<br />Conclusion: In older patients diagnosed with UTUC, SU could offer lower rates of post-operative complications without affecting survival.<br /> (Copyright © 2022. Published by Elsevier Inc.)
- Subjects :
- Aged
Glomerular Filtration Rate
Humans
Nephrectomy adverse effects
Nephrectomy methods
Nephroureterectomy methods
Postoperative Complications epidemiology
Postoperative Complications etiology
Retrospective Studies
Carcinoma, Transitional Cell pathology
Ureter surgery
Ureteral Neoplasms pathology
Urinary Bladder Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1938-0682
- Volume :
- 20
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical genitourinary cancer
- Publication Type :
- Academic Journal
- Accession number :
- 35125302
- Full Text :
- https://doi.org/10.1016/j.clgc.2022.01.007