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A large single-center study found that endoscopic kidney-sparing surgery (eKSS) is a viable option for most patients with upper tract urothelial carcinoma (UTUC), with fewer than 1 in 4 ultimately needing radical kidney removal. However, high-risk patients faced significantly greater odds of metastasis and cancer-specific death compared to low-risk patients, underscoring the importance of risk-based patient selection.
A long-term observational study of 254 patients with upper tract urothelial carcinoma (UTUC) found that endoscopic kidney-sparing surgery (eKSS) can provide durable cancer control while preserving kidney function — but outcomes vary significantly by risk category. Only 22% of patients ultimately required radical nephroureterectomy (RNU), the more aggressive surgical option, suggesting eKSS is feasible for a broad population when paired with rigorous surveillance.
The study, published in European Urology Oncology, followed patients for a median of 67 months and stratified them by European Association of Urology (EAU) risk criteria. While recurrence rates were similar between high- and low-risk groups, high-risk patients faced meaningfully worse outcomes in terms of disease progression and survival.
By the Numbers:
Why it matters: These findings offer real-world benchmarks to guide risk-adapted treatment decisions for UTUC, validating current EAU risk stratification in the endoscopic era and helping clinicians identify which patients can safely avoid radical surgery.
