Conservative treatment of upper urinary tract carcinoma in patients with imperative indications

BaCKgroUNd: To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. MeThodS: retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson Comorbidity index (CCi). The primary endpoint of the study was overall survival (oS). Secondary outcomes were recurrence-free survival (rFS) rates, complication rates and global renal function. reSUlTS: a total of 29 patients were enrolled in the study. The median age was 69.0 (iQr 63.0-79.0) years and the median CCi was 6 (iQr 4-8). overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-dindo grade iii and iV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (iQr 14-35). during the follow-up, 2 (6.9%) patients died for cause not related to cancer. recurrence of UTUC occurred in 18 patients (61.1%). The 24-month oS was 96.4±3.5% and the 24-month rFS was 31.7±9.4%. lower rFS rates were found in high grade tumor patients (22.2±13.9%) compared to low grade tumor patients (35.6±12.3%) (p=0.237). There was statistical difference in creatinine and egFr values when comparing baseline to last follow-up (p=0.018 and p=0.005, respectively). CoNClUSioNS: endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. however, stringent endoscopic follow-up is necessary due to the high risk of disease recurrence.