Distal ureterectomy is a safe surgical option in patients with urothelial carcinoma of the distal ureter

Objectives: We evaluated cancer-specific survival (CSS) and recurrence-free survival (RFS) rates of open distal ureterectomy (DU) compared with radical nephroureterectomy (RNU) for urothelial carcinoma of the distal ureter. Methods and materials: We retrospectively considered patients with urothelial carcinoma of the distal ureter who underwent DU or RNU at our department. Survival analysis and Cox regression models compared CSS and RNU after DU and RNU. RFS was evaluated separately for bladder and upper tract. Covariates were age, gender, symptoms at diagnosis, pathologic stage and grade, associated carcinoma in situ, surgical margins, lympho-vascular invasion, multifocality, necrosis, and previous or concomitant bladder cancer. Results: Forty-nine and 42 patients underwent DU and RNU, respectively. Median patients' follow-up was 51.5 months (range 4-290 mo). Two patients (4%) in the DU group were diagnosed with a recurrence in the ipsilateral upper tract after 63 and 45 months, respectively. Both patients underwent nephroureterectomy and are still alive in strict follow-up for non-muscle invasive bladder recurrence. Contralateral upper tract recurrence was observed in 1 and 3 patients in the RNU and DU group, respectively. At 5 years, CSS and RFS (upper tract) rates were 77% and 91% for DU and 78% and 96% for RNU, respectively. On univariable and multivariable analyses the type of surgery did not influence CSS and RFS (P = 0.92 and P = 0.94). Conclusions: DU is a safe surgical option in patients with urothelial carcinoma of the distal ureter and does not compromise oncologic outcomes compared with RNU. (C) 2014 Elsevier Inc. All rights reserved.