Open access for advanced cancer
At stage T3–T4 and enlarged lymph nodes, open surgery provides radical removal of the tumor with perinephric tissue, psoas muscle or peritoneal area during germination, as well as lymph node dissection along the aorta and vena cava (for the right kidney) or along the aorta (for the left). The orifice of the ureter with the bladder cuff is resected under visual control, and the bladder is sutured. Blood loss and recovery are greater than with laparoscopy (6–8 weeks), but for advanced tumors, open access increases radicality; further — adjuvant chemotherapy according to histology.
Cancer of the pelvis and ureter
Urothelial cancer of the upper urinary tract is 10 times less common than bladder cancer and is manifested by blood in the urine, lower back pain, and hydronephrosis. The standard of treatment for high-risk tumors is radical nephroureterectomy with resection of the orifice: removal of the entire ureter is mandatory, since the tumor is prone to recurrence in its stump. For small low-grade tumors and a solitary kidney, endoscopic laser treatment with follow-up is possible.
After surgery
On the first day after surgery, a chemotherapy drug is injected into the bladder once - this reduces the frequency of relapses in the bladder, which develop in 20-40% of patients. Observation includes cystoscopy every 3 months, urine cytology and MSCT. If lymph nodes are affected or there is invasion beyond the pelvis, adjuvant chemotherapy is prescribed. The remaining kidney provides function; with reduced function, treatment is agreed with a nephrologist.
