ORGAN-SPARING TREATMENT FOR URETERAL CARCINOMA

Objective: Nephroureterectomy (NUE) with a bladder cuff is the standar d therapy for ureteral cancer. Based on an analysis of the literature and a retrospective study, this concept is questioned. Methods: Betwee n 1980 and 1991, 40 patients with ureteral tumors underwent surgery at the Krankenhaus der Barmherzigen Bruder in Munich. Tumoral stages wer e pT(a) and pT(l) in 62% of the patients; 37% showed an invasive carci noma. Radical surgery (NUE with bladder cuff) was performed in 22 pati ents and conservative treatment (ureterocystoneostomy or end-to-end-an astomosis) in 13 patients. Results: The median follow-up was 42 months in the conservative group and 59 months in the radical surgery group. A recurrence in the conservatively operated patients was observed onl y in primary invasive tumors (4/13), whereas none of the remaining pat ients had a recurrent tumor. In terms of time to progression and tumor -specific survival, there was a good correlation of the ureteral carci noma according to grading and staging. In terms of survival, patients with superficial tumors run a similar course whether treated by conser vative or radical surgery. Conclusion: The conservative treatment of p atients presenting with superficial ureteral lesions seems to be a goo d alternative to radical surgery.