Surgical management for upper urinary tract transitional cell carcinoma

Bhavan Prasad Rai, Mike Shelley, Bernadette Coles, Chandra S. Biyani, Ismail El-Mokadem, Ghulam Nabi

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    Abstract

    Background

    Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures.

    Objectives

    To determine the best surgical management option for upper tract transitional cell carcinoma.

    Search strategy

    A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science (R), Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings.

    Selection criteria

    The following criteria that were considered for this review.

    Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma.

    Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma.

    Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes.

    Data collection and analysis

    Two review authors examined the search results independently to identify trials for inclusion.

    Main results

    We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P < 0.001) and mean time to discharge (2.3 days versus 3.7, P < 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups.

    Authors' conclusions

    There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach.

    This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    Original languageEnglish
    Article numberCD007349
    Pages (from-to)-
    Number of pages26
    JournalCochrane Database of Systematic Reviews
    Issue number4
    DOIs
    Publication statusPublished - 2011

    Keywords

    • LAPAROSCOPIC RADICAL NEPHROURETERECTOMY
    • RENAL PELVIS
    • UROTHELIAL CARCINOMA
    • OPEN SURGERY
    • RETROPERITONEOSCOPIC NEPHROURETERECTOMY
    • CONSERVATIVE MANAGEMENT
    • ENDOSCOPIC TREATMENT
    • ONCOLOGIC OUTCOMES
    • DISTAL URETER
    • FOLLOW-UP

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