Oncologic and renal function outcomes of segmental ureterectomy vs. radical nephroureterectomy in upper tract urothelial carcinoma: A systematic review and meta-analysis.

Abstract

Radical nephroureterectomy (RNU) remains the standard of care for patients with upper tract urothelial carcinoma (UTUC). Segmental ureterectomy (SU) has gained traction, given its benefit of preserving renal function without compromising oncologic control, particularly in low-risk disease. However, concerns persist regarding its oncological safety. We aimed to evaluate the oncologic and renal function outcomes in patients who underwent SU and RNU for UTUC. In August 2024, we systematically searched PubMed, Embase, Medline, and Cochrane databases to identify studies comparing oncologic outcomes and renal function preservation in patients who underwent SU and RNU for UTUC. Primary outcomes were cancer-specific survival (CSS), estimated glomerular filtration rate (eGFR) changes, and postoperative eGFR. Secondary outcomes included overall survival (OS), recurrence-free survival (RFS), and metastasis-free survival (MFS). Twenty-nine studies totaling 33,241 patients were included. No significant difference in 5-year CSS was observed between SU and RNU (HR 1.04, [95% confidence interval 0.93. 1.15], P = .49). A statistically significant higher 1-year postoperative eGFR (MD 17, [7.33, 26.67], P = .0006) and less pronounced eGFR change (MD 0.70, [0.24, 1.16], P = .003) were observed in the SU group. Additionally, the 5-year OS, RFS, and MFS were comparable between the groups. SU yielded comparable oncological outcomes to RNU concerning 5-year CSS, OS, RFS, and MFS while providing a higher postoperative eGFR and lower eGFR change at 1-year follow-up. SU might represent a viable treatment modality for UTUC in low-risk and carefully selected high-risk patients, although high-quality prospective trials implementing standardized outcome reporting are needed to draw definitive conclusions.