Gibt es Indikationen zur organerhaltenden Tumorresektion bei Urothelkarzinomen des oberen Harntraktes?

Zusammenfassung

Zielsetzung: Identifikation von Prognosefaktoren für ein Tumorrezidiv in der operierten renalen Einheit und einen Tumorprogress nach organerhaltender Chirurgie. Patienten und Methode: Von 06/1989 bis 02/2003 wurden 43 Patienten (47 renale Einheiten) wegen eines Urothelkarzinoms des oberen Harntrakts organerhaltend operiert, 26 (60,5 %) unter elektiver Indikation (gesunde kontralaterale Niere). Ergebnisse: Der mittlere Follow-up betrug 39,2 Monate (range 10,6 - 168,3). Ipsilaterale Rezidive wurden in 13 reno-ureteralen Einheiten (27,6 %) entdeckt. Rezidive traten signifikant häufiger bei einer Tumorlokalisation im Nierenbecken bzw. -abgang gegenüber einer Lokalisation im Ureter auf (p = 0.018). Ein Tumorprogress trat bei 8 von 43 Patienten (18,6 %) auf und war signifikant verbunden mit dem T- und G-Stadium des Primärtumors. (p = 0.006 und p = 0.002) Von den 47 konservativ behandelten renalen Einheiten wurden 38 (80,8 %) erhalten. Schlussfolgerung: Organerhaltende Resektionen bei Urothelkarzinomen des oberen Harntraktes sind eine Alternative bei einigen Patienten mit gut differenzierten oberflächlichen Tumoren. Ein lebenslanger Follow-up und eine gute Patientencompliance sind erforderlich. Nierenbeckentumore haben eine signifikant höhere Rezidivrate als Harnleitertumore. Entdifferenzierte Tumore sollten nur in Palliativsituationen organerhaltend behandelt werden und bei einigen Patienten mit Einzelniere nach intensive Beratung über hohes Risiko für invasive Rezidive und Ausbildung einer metastasierenden Erkrankung.

Abstract

Purpose: Identification of prognostic factors for tumor recurrence in nephronsparing surgery and tumor progression after organ-preserving surgery. Material and Methods: From June 1989 to February 2003, 43 patients (47 nephron units) underwent organ-preserving surgery or the upper urinary tract because of urothelial carcinoma, with 26 (60.5 %) having an elective indication (healthy contralateral kidney). Results: The mean follow-up was 39.2 months with a range of 10.6 to 168.3 months. Ipsilateral recurrences occurred in 13 (27.6 %) of reno-ureteral units. Recurrences were significantly more common for tumors located in the renal pelvis or opposite the ureteral origin (p = 0.018). Tumor progression occurred in 8 of 43 patients (18.6 %) and significantly correlated with the T- and G-stage of the primary tumor (p = 0.006 and p = 0.002). Of the 47 conservatively treated reno-ureteral units, 38 (80.8 %) could be preserved. Conclusion: Organ-preserving resection of the urothelial carcinoma of the upper urinary tract is an alternative in some patients with well-differentiated superficial tumors. A follow-up for life and a good patient compliance are necessary. Tumors of the renal pelvis have a significantly higher recurrence rate than ureteral tumors. Poorly differentiated tumors should undergo organ-preserving surgery only if the goal is palliation and in patients with solitary kidney after intensive consultation about the high risk of invasive recurrences and the development of metastases.

Neoplasma - Ureter - Nierenbecken - Harnblase - Übergangsepithelkarzinom

Neoplasm - ureter - renal pelvis - bladder - transitional cell carcinoma - surgery

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