What is the role of surgery in renal transitional cell carcinoma treatment?

Updated: Nov 05, 2019
  • Author: Bagi RP Jana, MD, MBA, MHA, FACP; Chief Editor: E Jason Abel, MD  more...
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Answer

Patients with low-stage, low-grade tumors respond well to either radical or conservative surgical treatment. In a retrospective review of patients treated with renal-sparing ureteroscopic management, Pak et al reported that renal preservation approached 81%, with cancer-specific survival of 94.7% and significant cost savings over the cost of nephroureterectomy; these authors recommend conservative endoscopic management as the gold standard for low-grade and superficial-stage disease. [25] However, preoperative cytology and ureterorenoscopically-performed biopsies have limited accuracy in predicting the correct tumor grade. Additional diagnostic procedures should be done prior to definitive surgical intervention. [26]

Patients with high-stage, high-grade tumors respond poorly to either radical surgery or conservative surgery.

Patients with positive cytologic findings but normal radiographic and endoscopic examinations are not treated but are monitored closely by means of periodic intravenous urography (IVU) or retrograde pyelography (RPG).


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