Intervention Review

Surgical management for upper urinary tract transitional cell carcinoma

  1. Bhavan Prasad Rai2,
  2. Mike Shelley3,
  3. Bernadette Coles4,
  4. Chandra S Biyani5,
  5. Ismail El-Mokadem2,
  6. Ghulam Nabi1,*

Editorial Group: Cochrane Prostatic Diseases and Urologic Cancers Group

Published Online: 13 APR 2011

Assessed as up-to-date: 5 SEP 2010

DOI: 10.1002/14651858.CD007349.pub2

Database Title

Additional Information

How to Cite

Rai BP, Shelley M, Coles B, Biyani CS, El-Mokadem I, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD007349. DOI: 10.1002/14651858.CD007349.pub2.

Author Information

  1. 1

    Division of Clinical and Population Sciences, University of Dundee, Department of Urology, Academic Clinical practice, Dundee, Scotland, UK

  2. 2

    Division of Clinical and Population Sciences, University of Dundee, Department of Urology, Academic Clinical Practice, Dundee, UK

  3. 3

    Velindre NHS Trust, Cochrane Prostatic Diseases and Urological Cancers Unit, Research Dept, Cardiff, Wales, UK

  4. 4

    Cardiff University, Cancer Research Wales Library, Cardiff, UK

  5. 5

    Pinderfield General Hospital and Mid Yorkshire NHS Trust, Department of Urology, Wakefield, West Yorkshire, UK

*Ghulam Nabi, Department of Urology, Academic Clinical practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, Scotland, DD1 9SY, UK. g.nabi@dundee.ac.uk.

Publication History

  1. Publication Status: New
  2. Published Online: 13 APR 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

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 methods

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®, 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Surgery for upper tract transitional cell carcinoma

Upper tract transitional cell carcinoma is an uncommon cancer mainly affecting the draining system of the kidney (kidney pelvis) and ureter (the tube through which urine passes from the kidney to the bladder). The main treatment approach for this condition is surgical removal of the malignant area. There are a number of surgical techniques for this procedure and the aim of this review was to compare them and determine which was the most effective in terms of surgical ease, patient morbidity, clinical outcome and cost. Our search of the literature found no high quality evidence comparing different surgical techniques. Evidence from one small randomised trial and observational studies suggests that laparoscopic surgical intervention may reduce blood loss, post-operative pain and hospital stay. However, the quality of the evidence is poor and, therefore, it is not possible to recommend the most effective surgical procedure to replace the existing clinical practice for managing upper tract transitional cell carcinoma.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Tratamiento quirúrgico para el carcinoma de células transicionales de las vías urinarias superiores

Los carcinomas de células transicionales (CCT) de las vías urinarias superiores son tumores poco frecuentes y agresivos. Hay varios enfoques quirúrgicos para tratar esta enfermedad, incluida la nefroureterectomía radical abierta y los procedimientos laparoscópicos.

Objetivos

Determinar la mejor opción de tratamiento quirúrgico del carcinoma de células transicionales de las vías urinarias superiores.

Estrategia de búsqueda

Se desarrolló una estrategia de búsqueda sensible para identificar estudios relevantes para la inclusión en esta revisión. Se realizaron búsquedas en las siguientes bases de datos para encontrar ensayos aleatorios que evalúen enfoques quirúrgicos para el tratamiento del CCT de las vías urinarias superiores: Medline EMBASE, Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts e ISI Proceedings.

Criterios de selección

Se consideraron los siguientes criterios para esta revisión:

Tipos de estudios: todos los ensayos controlados aleatorios o cuasialeatorios que compararon varios métodos quirúrgicos y otros enfoques para el tratamiento del carcinoma de células transicionales de las vías urinarias superiores. Tipos de participantes: todos los pacientes adultos con carcinoma de células transicionales localizado. La enfermedad localizada se definió como la limitada al riñón o al uréter sin aumento de volumen evidente de los ganglios linfáticos regionales en la imaginología. Tipos de intervenciones: cualquier método o enfoque quirúrgico para el tratamiento del carcinoma de células transicionales de las vías urinarias superiores localizado. Tipos de medidas de resultado: la supervivencia general y específica del cáncer fueron los resultados primarios. Morbilidad relacionada con la cirugía. La calidad de vida y los resultados económicos sanitarios fueron resultados secundarios.

Obtención y análisis de los datos

Dos autores de la revisión examinaron de forma independiente los resultados de la búsqueda para identificar ensayos para su inclusión.

Resultados principales

Se identificó un ensayo controlado aleatorio que cumplió los criterios de inclusión. El ensayo mostró que el enfoque laparoscópico tuvo resultados perioperatorios superiores comparado con el enfoque abierto. El enfoque laparoscópico fue superior y estadísticamente significativo para la pérdida sanguínea (104 ml [mililitros] versus 430 ml; p < 0,001) y el tiempo medio hasta el alta (2,3 días versus 3,7 días; p < 0,001). Los resultados oncológicos (supervivencia libre de tumor vesical, supervivencia libre de metástasis, curvas de supervivencia específicas del cáncer) a una mediana de seguimiento de 44 meses y en la enfermedad limitada al órgano fueron comparables para ambos grupos.

Conclusiones de los autores

No hay pruebas de alta calidad disponibles de ensayos adecuadamente controlados para determinar el mejor tratamiento quirúrgico del carcinoma de células transicionales de las vías urinarias superiores. Sin embargo, un ensayo aleatorio pequeño y datos observacionales indican que el enfoque laparoscópico se asocia con menos pérdida sanguínea y una recuperación temprana de la cirugía con resultados similares del cáncer, en comparación con el enfoque abierto.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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