Open Radical Nephroureterectomy for Upper Urinary Tract Carcinoma: Revisiting the Gold Standard

Abstract

Upper urinary tract carcinoma (UTUC) is a rare but aggressive malignancy affecting the renal pelvis and ureter. Radical nephroureterectomy (RNU) with bladder cuff excision remains the gold standard for managing high-risk, non-metastatic UTUC. While minimally invasive approaches have gained popularity, open excision remains a vital technique, especially in complex cases. This review aims to provide a comprehensive overview of open excision in radical nephroureterectomy, focusing on surgical techniques, oncological outcomes, perioperative considerations, and complication management. A systematic review of current literature was performed, analyzing studies comparing open RNU with laparoscopic and robotic approaches. Key parameters included surgical technique variations, patient selection criteria, oncological efficacy, complication rates, and long-term survival outcomes. Open radical nephroureterectomy continues to offer excellent oncological control, particularly in cases with advanced disease, large tumors, or anatomical complexities. Despite longer recovery times and increased blood loss compared to minimally invasive approaches, open RNU demonstrates superior lymph node dissection capabilities and complete excision of the distal ureter and bladder cuff. Open excision in radical nephroureterectomy remains a cornerstone in the surgical management of upper urinary tract carcinoma, particularly for advanced or challenging cases. Continued refinement of surgical techniques and comparative studies are essential to optimize outcomes and patient quality of life.