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Treatment of transitional cell carcinoma of the ureter: is the controversy justified?

Between 1938 and 1985, 73 patients with ureteral tumors underwent surgery at Puigvert Foundation (1 case with bilateral synchronous tumors). Sixty-three patients were males and 10 females. Ages ranged between 49 and 78 (mean of 62) years. Tumoral stages were: pTa 5 cases; pT1 56 cases; pT2 10 cases, and pT3 2 cases. Radical treatment was performed in 38 cases and conservative treatment in 35 cases. Follow-up ranged between 2 and 20 (mean of 7) years. The overall survival rate at 5 years was 100, 82 and 50% for stages pTa, pT1 and pT2-3, respectively (p less than 0.05). Analyzed together, the actuarial survival at 5 years was 90.3% with conservative surgery and 67.8% with radical surgery (p not significant). The survival by stages for the patients treated with radical surgery was: 100% in pTa; 69.6% in pT1, and 57.1% in pT2-3. For those treated conservatively, survival was 100% in pTa, 95.8% in pT1 and 33.3% in pT2. Thus patients presenting with infiltrating tumors should not be treated conservatively, while patients with superficial lesions had a similar evolution whether treated by conservative or radical surgery.