Surgery for upper urinary tract urothelial cancer (UTUC)
About surgery for upper urinary tract urothelial cancer
Surgery is usually the main treatment for UTUC that has not spread to other parts of the body.
Surgery may be open or keyhole (laparoscopic).
In general, if you have keyhole surgery you may not need to stay in hospital for as long. Recovery from keyhole surgery is usually quicker than from open surgery.
Open surgery
Keyhole (laparoscopic) surgery
During keyhole surgery, the surgeon makes 3 to 5 small cuts. They pass a telescopic camera (laparoscope) through one of the cuts. It sends video images to a monitor. The surgeon will then pass special surgical tools through the other cuts to remove the cancer. One of the cuts may be bigger so the surgeon can remove the kidney and ureter.
The surgeon may also use a specialised machine to help with keyhole surgery. The machine has cameras and very small surgical tools attached to robotic arms which the surgeon controls. This is called robot-assisted surgery. It makes it possible for the surgeon to do very precise surgery.
Some types of keyhole surgery may only be available at larger cancer centres. This means you may have to travel for treatment. Your surgeon will talk to you about which type of surgery is best for you.
Related pages
Removing the kidney and ureter (nephroureterectomy)
This is the most common operation to treat UTUC. The surgeon removes:
- the kidney
- a layer of fat around the kidney
- the ureter
- an area of tissue where the ureter enters the bladder (bladder cuff).
The surgeon may also remove some lymph nodes close to the kidney to check whether they contain cancer cells.
You will have a tube (catheter) put in during the operation to drain urine from your bladder. This may be removed before you leave hospital. But you may go home with it to let your bladder heal.
You may have 1 dose of chemotherapy into the bladder after your surgery. This is to help reduce the risk of cancer coming back. This is called intravesical chemotherapy. If you have a low risk of the cancer coming back, you usually do not need chemotherapy.
Removing a kidney and ureter is a big operation. It is not suitable for everyone. Your doctors may need to do tests to check you are well enough to cope with the surgery.
Removing part of the kidney
Removing part of the ureter
Sometimes, if the cancer is in the lower third of the ureter, it may be possible to only remove part of the ureter. This is called a segmental ureteric resection.
The surgeon removes:
- the part of the ureter where the tumour is
- a healthy area (margin) of ureter above the tumour
- all the ureter below the tumour.
Then they reattach the remaining ureter to the bladder.
Endoscopic surgery
It is sometimes possible to remove a low grade, early stage tumour in the renal pelvis using endoscopy. The surgeon passes a flexible tube with a camera called an endoscope up through the urethra, bladder and ureter to the renal pelvis. This is called a ureteroscopy. The surgeon then removes the tumour using tools passed through the endoscope.
Sometimes the surgeon makes a small cut in your back to reach the kidney. This is called a percutaneous renoscopy. They then pass the endoscope into the kidney to reach the renal pelvis.
If you only have 1 kidney, you may have endoscopic surgery for higher grade cancers. Or you may have it if your kidneys do not work well enough for you to cope with just 1 kidney.
After surgery
Some people will have cancer drugs after surgery. This is called adjuvant treatment. The aim is to reduce the risk of cancer coming back. We have more information about cancer drugs for UTUC.
If you have had part or all of a kidney removed, your remaining kidney tissue and other kidney will usually be able to do the work of both kidneys. Your cancer team will check this is happening with regular blood tests.
Possible complications of surgery
The most common complications after surgery are:
- a wound infection
- bleeding
- a chest infection
- a blood clot.
The nurses will monitor you. They will give you injections to reduce the risk of blood clots developing. Tell them straight away if you:
- have fevers or feel unwell
- have any bleeding
- notice swelling and redness in a limb (arm or leg)
- have any symptoms of an infection, such as a cough or a leaking wound.
Going home after surgery
How long you stay in hospital depends on the type of operation you have and how quickly you recover.
After keyhole surgery, most people go home after 2 to 5 days.
After open surgery, most people go home after 5 to 7 days.
Your body uses a lot of energy to heal. It is common to feel more tired than usual for about 6 weeks after the operation. Most people feel fully recovered after about 12 weeks.
You will not be able to do some everyday activities while you recover. For example, you may not be able to shop, drive, have sex, play sport or work. Your nurse or surgeon can tell you when you will be able to do these things again.
Before you leave hospital, you will be given an appointment for a check-up. This is usually about 6 weeks after your operation. It will be at an outpatient clinic. The appointment is a good time to ask questions or talk about any problems you have after your operation.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our UTUC information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Rouprêt M, Gontero P, Birtle A et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma. 2023. Available from https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
University College Hospitals, London
Date reviewed
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