Tuininga, A.M.A. (2016) Endoscopische laserablatie versus radicale nefro-ureterectomie als behandeling van patiënten met een laaggradig urotheelcelcarcinoom: management en overleving. thesis, Medicine.
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Abstract
BACKGROUND – Upper Tract Urothelial Carcinoma (UTUC) is a rare condition. Recently a new, less invasive, treatment has been established, namely uteroscopic laser ablation (URSa). In contrast to the golden standard of treatment, radical nephro-ureterectomy (RNU), there is no need of removal of the kidney in URSa. So far comparisons between these treatments have shown a selection bias, whereby in particular low-grade and non-invase tumours are treated by URSa and the opposites, high-grade and invasive tumours, are treated by RNU. The aim of this study is to describe differences in renal function and survival of patients diagnosed with low-grade UTUC and treated by URSa or RNU. METHODS – Retrospective analysis took place of all low-grade UTUCs (n = 75) treated by URSa or RNU from January 1991 to May 2016 at the University Medical Center Groningen and from Januari 2008 to May 2016 at Isala Hospital Zwolle. The primary outcome was renal function. Secondary outcomes were overall survival, recurrence free survival, disease specific survival and postoperative complications. RESULTS – The URSa group contained 40 patients and the RNU group respectively 35. Preoperative renal function showed no difference between the two treatments. One year postoperatively renal function decreased significantly in the RNU group (p = 0.020), but not in the URSa group (p = 0.581). No patient reached renal dialysis. The overall survival of the two groups showed no difference (p = 0.971). The moment when the first lower-tract urothelial cell carcinoma (UCC) developed showed no difference between the two groups (p = 0.267). Thirty percent of the URSa group underwent a RNU after primary URSa treatment, with a median duration of 15 months since diagnosis. The overall survival of this subgroup showed no difference from the RNU group. CONCLUSION – A low-grade UTUC may initially be treated safely with URSa in order to preserve renal function. If necessary, RNU can be performed after initial URSa treatment, which does not seem to influence overall survival.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider and Roemeling, Dr. S. uroloog and Universitair Medisch Centrum Groningen and Afdeling Urologie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1711 |
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