Table 1.
Studies on endoscopic laser ablation (ELA) in patients with upper urinary tract urothelial carcinoma (UTUC)
| Author (year) | Country | Study design | Type of technique | Cases (n) | Age (yr) | Grade (HG–G3), n (%) | Postoperative complications, n (%) | Mean follow-up (mo) | Overall survival (%) | Cancer–specific survival (%) | Bladder recurrence, n (%) | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Niţă (2012) [9] | Romania | Retrospective | Nd:YAG or resection | 65 | 67 | 15 (71.4) | – | 60 | – | 5 yr: 52.3% | 20 (30.7) | The most important prognostic factors for UTUC progression are tumor location, size, and grade |
| Martínez-Piñeiro (1996) [10] | Spain | Retrospective | Nd:YAG or resection | 42 | 62.2 | 10 | UUT perforation: 6 (14) Colon perforation: 1 (2.3) Ureteral stricture:7 (16.7) |
31 | – | – | 10 (23.8) | ELA for superficial UTUC is a safe procedure, with low complication rates and moderate recurrence rates |
| Blute (1989) [11] | USA | Retrospective | Nd:YAG or resection | 21 | 65 | 3 (14) | Fever: 2 (9.5) UUT perforation: 3 (14) |
33 | – | – | 4 (19) | Conservative endourological techniques can safely be employed to manage specific cases of UTUC |
| Elliott (1996) [12] | USA | Retrospective | Nd:YAG or electrocautery | 21 | 69 | 6 (29) | UUT perforation: 2 (9.5) Fever: 4 (19) Ureteral stricture: 6 (28.6) |
72 | 5 yr: 66% | – | 44 (43.2) | UTUC can be managed by ELA in selected cases |
| Jabbour (2000) [13] | France | Retrospective | Nd:YAG laser | 61 | – | 0 (0) | – | 48 | – | 4 yr: 95% | – | The low sensitivity and specificity of urine cytology and radiography warrant close and vigilant long-term endoscopic follow-up, especially for stage T1 tumors |
| Jimie (2022) [14] | UK | Retrospective | Diode laser | 30 | 76 | 9 (30) | Hematuria: 1 (3.3) AKI: 1 (3.3) AUR: 1(3.3) Vomiting: 2 (6.7) |
30 | – | – | – | Diode laser proved to be a safe and effective approach for managing UTUC in patients who are not suitable candidates for RNU |
| Matsuoka (2003) [15] | Japan | Prospective | Ho:YAG | 30 | – | 0 (0) | Ureteral stricture: 1 (3.3) | 20 | – | 3 yr with elective indication: 95% 3 yr with imperative indication: 57% |
5 (17) | Ho:YAG laser can be a useful method in limited cases identified in specific treatments groups combined with a strict follow-up |
| Rouprêet (2006) [16] | France | Retrospective | Ho:YAG | 27 URS 16 PEA |
68 | 8 (29.6) URS 5 (31.2) PEA |
URS: 2 perforation requiring urinary stent placement and 1 case of bleeding requiring endoscopic surgery PEA: 0 |
57.5 median | – | 5 yr URS: 80.7% 5 yr PEA: 80% |
5 (12) | Conservative surgery can be recommended for LG or superficial UTUC, determining similar CSS and BR to RNU |
| Painter (2008) [17] | UK | Retrospective | Ho:YAG and/or Nd:YAG | Elective group: 19 Relative group: 16 Palliative group:10 |
65 | Elective group: 0 (0) Relative group: 12 (75) Palliative group: 8 (80) |
Ureteral stricture: 2 (4.4) | 24 | 2 yr elective group: 90% Relative group: 62.5% Palliative group: 70% |
2 yr elective group: 90% | – | ELA is a valid option in elective cases. Even in imperative indications, endoscopic treatment is a safe and feasible approach |
| Cornu (2010) [18] | France | Retrospective | Ho:YAG | 35 | 67 | 6 (17.1) | Sepsis: 2 (5.7) AKI: 1 (2.8) |
30 | 3 yr: 100% | 3 yr: 100% | 23 (65) | ELA can be advocated in selected cases of UTUC as an alternative to RNU |
| Hoffman (2014) [19] | Israel | Retrospective | Ho:YAG | 25 | 64 | 0(0) | – | 26 | 4 yr: 70% | 5 yr: 100% | 11 (44) | EA for LG UTUC guarantees similar CSS to RNU, despite a higher rate of BR |
| Villa (2018) [20] | Italy | Prospective | Ho:YAG | 112 | 69.7 | 13 (14.1) | – | 52.4 | – | 2 yr: 77% | 70 (76.1) | ELA is a valid option in selected cases of UTUC. Tumor size >1 cm and multifocality do not contraindicate the procedure |
| Musi (2018) [21] | Italy | Prospective | Thu:YAG | 42 | 68 | 4 (9) | CD I: 16 (38) CD II: 15 (35.7) CD III: 1 (2.4) |
60 | – | – | – | EA with thulium laser is a safe and effective technique for UTUC treatment. It guarantees optimal lesion vaporization and fine hemostatic control without any major complication |
| Wen (2018) [22] | China | Retrospective | Thu:YAG | 32 | 69.3 | 5 (16) | 0 (0) | – | – | – | 7 (35) | Thulium laser group is associated with higher renal function preservation, but a higher rate of local recurrence |
| Bozzini (2021) [23] | Italy | Retrospective | Thu:YAG | 47 | 69.2 | 29 (37.2) | Hematuria: 12 (15.3) Infections: 9 (11.5) |
11.7 | – | – | 9 (17) | For a short term, thulium laser ablation of UTUC is safe and feasible, especially in low-grade UTUC |
| Proietti (2022) [24] | Italy | Retrospective | TFL | 28 | 73 | 8 (28.6) | CD I–II: 3 (10.7) CD IIIB: 1 (3.6) |
12 | – | 1 yr: 76.5% | – | TFL guarantees that optimal tumor ablation and fine hemostatic control were achieved without major complications in a short-term follow-up |
| Johnson (2005) [25] | USA | Retrospective | Nd:YAG and/or Ho:YAG laser | 35 | – | 14 (22) | Infundibular strictures: 2 (6) Ureteral stricture:1 (3) |
32 | – | – | – | ELA is recommendable for patients with LG UTUC, owing to the low tumor progression risk and low morbidity |
| Sowter (2007) [26] | UK | Retrospective | Nd:YAG and/or Ho:YAG laser or cautery | 37 | 65 | 4 (9.8) | – | 41.6 | – | – | 12 (34.3) | ELA is a is a safe and effective approach in LG UTUC or imperative cases |
| Suh (2003) [27] | USA | Retrospective | Nd:YAG and/or Ho:YAG laser or resection | 58 | 70.7 | 20 (33) | Hematuria: 4 (6.9) Flank pain leading to admission: 3 (5.2) Atrial arrhythmia: 2 (3.4) Ureteral stricture :2 (3.4) |
21.0 | – | – | – | Endoscopic treatment is associated with a high risk of local recurrence and retreatment. Patients with low-grade, solitary, or less bulky diseases have higher recurrence-free survival |
| Chen (2000) [28] | USA | Retrospective | Nd:YAG and/or Ho:YAG laser | 23 | 65 | 1 (4.4) | Ureteral strictures: 2 (8.8) | 35 | – | – | 7 (30) | ELA of small, low-grade UTUC can be a safe alternative treatment to RNU in patients with healthy contralateral kidneys |
| Boorjian (2004) [29] | USA | Retrospective | Nd:YAG and/or Ho:YAG laser | 38 | 70.9 | 2 (5) | – | 37.2 | – | 3 yr: 66% | – | Selective cytology examination may play a significant role in the decision-making process for patients with UTUC |
| Scotland (2020) [30] | USA | Retrospective | Nd:YAG and/or Ho:YAG laser | 168 | 70 | 28 (16.7) | Sepsis: 2 (1.2) UTI: 4 (2.4) Ureteral stricture: 1 (0.6) |
66 | 5 yr: 80.9% | 5 yr: 92.6% | – | ELA can guarantee satisfactory oncological outcomes for UTUC, especially low-grade ones, while sparing renal function |
| Shvero (2020) [31] | Israel | Retrospective | Nd:YAG and/or Ho:YAG laser | 59 | 70 | – | CD I: 12 (20.3) CD II: 7 (11.8) CD IIIa: 1 (1.6) CD IIIb: 4 (6.7) |
22 | – | 2 yr: 100% | 27 (45.7) | ELA for large, multifocal, low-grade UTUC guarantees short-term oncological outcomes, with a low comorbidity rate |
| Shen (2022) [32] | Taiwan | Retrospective | Nd:YAG and/or Ho:YAG laser | 23 | 66.0 | – | – | 33.6 | 5 yr: 94.5% | – | – | In Ta-T1 UTUC, ELA offers similar oncological outcomes to RNU. However, for high-grade tumors, strict surveillance is needed |
| Defidio (2019) [33] | Italy | Retrospective | Thu-Ho:YAG Duo laser |
178 | 70.8 | 60 (33.7) | CD I: 17 (9.6) | 28.7 | – | – | – | ELA with the thulium-holmium:YAG Duo laser has been proved to be a safe and effective treatment option, demonstrating long-term oncological radicality and minimal morbidity |
| Sanguedolce (2021) [34] | Italy | Prospective | Ho:YAG or Thu:YAG | 47 | 75 | 8 (17) | CD I: 1 (2.1) CD II: 4(8.5) |
24 | – | – | 11 (23.4) | ELA is a feasible procedure guaranteeing renal function preservation. Tumor size seems to be associated with BR, while the number of recurrences seems to be associated with UTUC progression |
| Proietti (2021) [35] | Italy | Retrospective | Ho:YAG and/or Thu:YAG | 29 with 137 procedures | 69 | 18 (62) | CD III: 3 (2.2) CD IV: 1 (0.7) |
24 | 2 yr: 96% | 2 yr: 31.3% | 9 (31) | ELA in patients with imperative indications is a feasible alternative to RNU |
AKI = acute kidney injury; AUR = acute urinary retention; BR = bladder recurrence; CD = Clavien-Dindo; CSS = cancer-specific survival; EA = endoscopic ablation; HG = high grade; Ho = holmium; LG = low grade; ND = neodymium; PEA = percutaneous endoscopic ablation; RNU = radical nephroureterectomy; TFL = thulium fiber laser; Thu = thulium; URS = ureteroscopy; UTI = urinary tract infection; UUT = upper urinary tract; YAG = yttrium-aluminum-garnet.