Background and purpose: Percutaneous endoscopic resection is a viable treatment option for upper-tract urothelial carcinoma (UC) in selected patients. We present our experience with patients who underwent percutaneous resections for complex urothelial tumors. Patients and Methods: Patients who were undergoing percutaneous treatment for UC were identified within a prospectively maintained database at a single institution. Charts were reviewed to identify complex patients (n=16) who met the following criteria: (a) tumor size >2.5cm (n=8), (b) preoperative creatinine level >3.0mg/dL (n=3), or (c) anatomic variant (cystectomy/urinary diversion [n=2]; autotransplanted kidney [n=1]; ipsilateral partial nephrectomy [n=1]; distal ureterectomy [n=1]). Demographic, operative, and oncologic data were captured. Recurrence-free, cancer-specific, and overall survivals were calculated and compared with a control group of noncomplex cases (n=23). Results: No difference was found in mean age (69.7±10.8 years vs 69.8±11.2 years), complication rate (6.3% vs 7.1%), or change in creatinine level (1.53mg/dL to 1.51mg/dL vs 1.88mg/dL to 1.57mg/dL) between noncomplex and complex cases. The incidences of high-grade tumors (55% vs 71%), invasive tumors (15% vs 20%), solitary kidney (82% vs 92%), contralateral nephroureterectomy (52% vs 60%), and history of bladder cancers (47% vs 38%) were similar between the two groups. Median follow-up was 36 months. No difference was seen in cancer-specific survival (P=0.98) or recurrence-free survival (P=0.39). An improved trend in overall survival (P=0.20) was seen in the noncomplex patients when compared with the complex group. Conclusions: These findings suggest that patients with large tumors, poor renal function, and significant anatomic variations may be well served by endoscopic treatment for upper-tract UC when indicated.
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