Challenges in Follow-up After Kidney-sparing Surgery for Upper Tract Urothelial Carcinoma: Insights from a Delphi Consensus
Year: 2025
Type: article
Abstract: BACKGROUND AND OBJECTIVE: Kidney-sparing surgery (KSS) is the preferred treatment for patients with low-risk upper tract urothelial carcinoma (UTUC), offering a balance between oncologic efficacy and renal preservation. However, follow-up protocols are lacking due to insufficient evidence, resulting in clinical variability. In response, a Delphi consensus process has been initiated with the aim to refine and establish unified surveillance recommendations following KSS for low-risk UTUC. METHODS: A multistage Delphi consensus project was conducted by an expert panel, which completed four rounds of questionnaires using both open-ended and Likert scale-based questions, with the goal of achieving consensus on four key topics. KEY FINDINGS AND LIMITATIONS: In total, 28 invited experts participated in the Delphi panel, achieving consensus on the primary goals of UTUC follow-up, including tumour recurrence detection, renal function preservation, and maintaining quality of life. While consensus was reached on key diagnostic modalities (kidney function, computed tomography urography, cystoscopy, and ureteroscopy) and follow-up adjustments based on treatment indications, the precise schedules and long-term follow-up duration remained unresolved. CONCLUSIONS AND CLINICAL IMPLICATIONS: This Delphi project underscores the challenges of standardising follow-up protocols after KSS for UTUC. A balanced approach is needed to ensure early recurrence detection while preserving renal function and quality of life. Robust data on prognostic factors are essential to better identify patients at risk of recurrence and to refine surveillance strategies. Collaborative research remains essential for developing evidence-based follow-up protocols for this rare disease.
Source: European Urology Oncology
Authors: Orlane Figaroa, Hugo Schuil, Guido Kamphuis, Luna van den Brink, Nora Hendriks, Michaël Henderickx, Adriaan Bins, Jeroen van Moorselaar, Leye Ajayi, Mieke Bus, Vitor Cavadas, Cecilia Maria Cracco, David D Andrea, Ranan Dasgupta, Vincent De Coninck, Otas Durutovic, Ida Ebbensgaard, Stefania Ferretti, Andrea Gallioli, Etienne Xavier Keller, Francis Xavier Keeley Jr, Palle Jörn Sloth Osther, Marcin Popiolek, Benjamin Pradere, Silvia Proietti, Iliya Saltirov, Bhaskar Somani, Thomas Tailly, Kay Thomas, Ben Turney, Øyvind Ulvik, Carl Van Haute, Bart van der Heij, Juan Luis Vasquez, Marianne Brehmer, Joyce Baard
Institutions: Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Vrije Universiteit Amsterdam, The Royal Free Hospital, University Medical Center Groningen, University of Groningen, Hospital de Santo António, Centro Hospitalar do Porto, Unidade Local de Saúde de Santo António EPE, Vienna General Hospital, Comprehensive Cancer Center Vienna, National Health Service, Imperial College Healthcare NHS Trust, AZ Klina, University of Belgrade, Herlev Hospital, University of Modena and Reggio Emilia, Universitat Autònoma de Barcelona, Puigvert Foundation, University of Zurich, University Hospital Zurich, North Bristol NHS Trust, Lillebaelt Hospital, Örebro University, IRCCS Ospedale San Raffaele, Military Medical Academy, University Hospital Southampton NHS Foundation Trust, Ghent University Hospital, Guy's Hospital, St Thomas' Hospital, Oxford University Hospitals NHS Trust, Haukeland University Hospital, KU Leuven, Zuyderland Medisch Centrum, University of Copenhagen, Copenhagen University Hospital, Zealand University Hospital, Karolinska Institutet, Stockholm South General Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
OpenAlex ID: W4413257397