SynthesisWorld journal of surgical oncology2026
Distal ureterectomy versus radical nephroureterectomy for nonmetastatic distal ureteral urothelial carcinoma: a GRADE-assessed systematic review and meta-analysis of comparative studies.
Synthesis in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal preservation is clinically desirable.
methodsA systematic review and meta-analysis of comparative studies was performed. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 27, 2026. A total of 229 records were identified, 14 full-text articles were assessed, and 6 studies were included. The primary outcome was a positive surgical margin. Secondary outcomes included intravesical recurrence, cancer-specific survival, lymph node metastasis, muscle-invasive disease (≥ pT2), and high-grade pathologic disease burden as a marker of baseline oncologic risk and treatment-selection balance. Random-effects models were used. Risk of bias was assessed with ROBINS-I, and certainty of evidence was evaluated using GRADE.
resultsA total of 6 comparative studies comprising 1,247 patients were included, of whom 588 underwent distal ureterectomy, and 659 underwent radical nephroureterectomy. DU was not associated with a significant difference in positive surgical margin compared with RNU (RR 1.24, 95% CI 0.64-2.43). Cancer-specific survival was also comparable (HR 0.97, 95% CI 0.72-1.29). No significant differences were observed for lymph node metastasis (RR 0.85, 95% CI 0.40-1.80), muscle-invasive disease (RR 0.96, 95% CI 0.86-1.08), or high-grade disease (RR 0.97, 95% CI 0.86-1.09). Intravesical recurrence was not significantly different in the primary pooled analysis (HR 1.36, 95% CI 0.89-2.07), although sensitivity analysis suggested a higher recurrence hazard after DU. Most outcomes were supported by very low to low certainty evidence.
conclusionsIn selected patients with nonmetastatic distal ureteral urothelial carcinoma, DU appears to preserve oncologic adequacy relative to RNU while offering a kidney-sparing surgical alternative. The main trade-off may be a higher risk of intravesical recurrence, underscoring the need for careful surveillance and individualized surgical decision-making.
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