{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:44:37Z","timestamp":1786164277731,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008108","name":"Taipei Tzu Chi Hospital","doi-asserted-by":"crossref","award":["TCRD-TPE-113-05(2\/3)"],"award-info":[{"award-number":["TCRD-TPE-113-05(2\/3)"]}],"id":[{"id":"10.13039\/501100008108","id-type":"DOI","asserted-by":"crossref"}]},{"award":["TCRD-TPE-113-05(2\/3)"],"award-info":[{"award-number":["TCRD-TPE-113-05(2\/3)"]}],"id":[{"id":"https:\/\/ror.org\/00q017g63","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"crossref","award":["TCRD-TPE-113-66 (2\/3 and 3\/3)"],"award-info":[{"award-number":["TCRD-TPE-113-66 (2\/3 and 3\/3)"]}],"id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"crossref"}]},{"award":["TCRD-TPE-113-66 (2\/3 and 3\/3)"],"award-info":[{"award-number":["TCRD-TPE-113-66 (2\/3 and 3\/3)"]}],"id":[{"id":"https:\/\/ror.org\/04rbvc675","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Radical nephroureterectomy (RNU) is the standard of care for high-risk upper tract urothelial carcinoma (UTUC) but causes permanent renal decline, often disqualifying patients from essential cisplatin-based adjuvant chemotherapy. Segmental ureteral resection (SUR) preserves renal function, but its safety in high-risk patients remains fiercely debated due to historical treatment selection biases and a lack of competing risk adjustments. We aimed to compare long-term oncological outcomes and postoperative renal function preservation between SUR and RNU for high-risk UTUC strictly localized to the ureter. Methods: Retrospective data from 859 patients (783 RNU, 76 SUR) with high-risk ureteral UTUC (high-grade or pathologic T2\u2013T4) were analyzed from a 21-hospital nationwide database. Propensity score overlap weighting was implemented to achieve covariate balance. Overall survival (OS) was assessed via Cox proportional hazards regression, whereas cancer-specific survival (CSS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) were evaluated using multivariable Fine\u2013Gray subdistribution hazard models to robustly account for the competing risk of non-cancer mortality. Results: Overlap weighting achieved excellent baseline comparability with an effective sample size of 429.5 patients per cohort. Weighted analyses demonstrated comparable long-term trajectories between SUR and RNU for OS (p = 0.62), CSS (hazard ratio [HR]: 0.94, p = 0.835), and MFS (HR: 0.88, p = 0.664). The Fine\u2013Gray model confirmed that the surgical approach was not a significant independent predictor of local recurrence (HR: 0.74, p = 0.351). Crucially, the SUR group demonstrated a significantly lower renal function decline both at 1 month (\u22120.11 vs. \u221210.58 mL\/min\/1.73 m2, p &lt; 0.001) and through final clinical follow-up (\u22125.33 vs. \u221212.49 mL\/min\/1.73 m2, p = 0.001). Conclusions: For meticulously selected patients with high-risk ureteral UTUC, SUR provides equivalent oncological control and survival outcomes to standard RNU. Crucially, this kidney-sparing approach significantly preserves postoperative renal function, safeguarding the physiological reserve required for patients to maintain eligibility for optimal subsequent systemic adjuvant therapies.<\/jats:p>","DOI":"10.3390\/cancers18152527","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:03:27Z","timestamp":1786021407000},"page":"2527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Oncological Outcomes of Segmental Ureteral Resection Versus Radical Nephroureterectomy for High-Risk Ureteral Urothelial Carcinoma"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6896-790X","authenticated-orcid":false,"given":"Yu-Hsiang","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Urology, National Taiwan University Hospital, Taipei 100225, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Hsiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Urology, China Medical University and Hospital, Taichung 404327, Taiwan"},{"name":"School of Medicine, China Medical University, Taichung 404328, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1429-1366","authenticated-orcid":false,"given":"Chi-Ping","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology, China Medical University and Hospital, Taichung 404327, Taiwan"},{"name":"School of Medicine, China Medical University, Taichung 404328, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-7416","authenticated-orcid":false,"given":"Wen-Jeng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807656, Taiwan"},{"name":"Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Chia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807656, Taiwan"},{"name":"Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Urology, School of Medicine, Mackay Medical College, Taipei 252005, Taiwan"},{"name":"Mackay Junior College of Medicine, Nursing, and Management, Taipei 112601, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wun-Rong","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Urology, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Urology, School of Medicine, Mackay Medical College, Taipei 252005, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1344-1505","authenticated-orcid":false,"given":"Chih-Chin","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City 231542, Taiwan"},{"name":"School of Medicine, Buddhist Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-2344","authenticated-orcid":false,"given":"Vincent F. S.","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City 231542, Taiwan"},{"name":"School of Medicine, Buddhist Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2833-5609","authenticated-orcid":false,"given":"Yao-Chou","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City 231542, Taiwan"},{"name":"School of Medicine, Buddhist Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1097\/JU.0000000000003480","article-title":"Diagnosis and management of non-metastatic upper tract urothelial carcinoma: AUA\/SUO guideline","volume":"209","author":"Coleman","year":"2023","journal-title":"J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.eururo.2025.02.023","article-title":"European Association of Urology guidelines on upper urinary tract urothelial carcinoma: Summary of the 2025 update","volume":"87","author":"Birtle","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1016\/j.eururo.2016.07.014","article-title":"Oncologic outcomes of kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: A systematic review by the EAU non-muscle invasive bladder cancer guidelines panel","volume":"70","author":"Seisen","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/iju.15192","article-title":"Impact of nephroureterectomy on postoperative renal function in upper tract urothelial carcinoma: A multicenter retrospective study","volume":"30","author":"Okuyama","year":"2023","journal-title":"Int. J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/bju.12597","article-title":"Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma","volume":"114","author":"Kaag","year":"2014","journal-title":"BJU Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2967","DOI":"10.1002\/cncr.25043","article-title":"Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy","volume":"116","author":"Lane","year":"2010","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1464-410X.2012.11649.x","article-title":"Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy","volume":"112","author":"Xylinas","year":"2013","journal-title":"BJU Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"529186","DOI":"10.1155\/2014\/529186","article-title":"Nomogram predicting renal insufficiency after nephroureterectomy for upper tract urothelial carcinoma in the Chinese population: Exclusion of ineligible candidates for adjuvant chemotherapy","volume":"2014","author":"Fang","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.urolonc.2025.05.011","article-title":"Oncologic and renal function outcomes of segmental ureterectomy vs. radical nephroureterectomy in upper tract urothelial carcinoma: A systematic review and meta-analysis","volume":"43","author":"Chew","year":"2025","journal-title":"Urol. Oncol."},{"key":"ref_10","unstructured":"National Comprehensive Cancer Network (2026). Bladder Cancer. NCCN Clinical Practice Guidelines in Oncology, National Comprehensive Cancer Network. Updated 16 March 2026."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1089\/end.2024.0061","article-title":"Kidney-sparing surgery has equivalent oncological outcomes to radical nephroureterectomy for ureteral urothelial carcinoma","volume":"38","author":"Liu","year":"2024","journal-title":"J. Endourol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhang, H., Tan, Q., He, Y., Zhang, T., and He, Y. (2026). Comparative analysis of oncologic outcomes: Kidney-sparing surgery versus radical nephroureterectomy for localized high-risk upper tract urothelial carcinoma. Front. Oncol., 16.","DOI":"10.3389\/fonc.2026.1753148"},{"key":"ref_13","first-page":"17883","article-title":"Comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy for upper urinary tract urothelial carcinoma","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Xie, J., Liu, Z., Zhou, P., Ye, J., Ye, Y., Li, Z., Li, X., Sun, Z., Xu, C., and Li, X. (2026). Comparative outcomes of distal ureterectomy vs. radical nephroureterectomy in high-risk distal ureteral urothelial carcinoma: A two-center cohort study in Northern and Southern China. BMC Med., 24.","DOI":"10.1186\/s12916-026-04632-2"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"661.e19","DOI":"10.1016\/j.urolonc.2025.06.023","article-title":"Comparative outcomes of radical nephroureterectomy and kidney-sparing surgery in the treatment of high-grade upper tract urothelial carcinoma","volume":"43","author":"Moore","year":"2025","journal-title":"Urol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8818","DOI":"10.1097\/JS9.0000000000003292","article-title":"Comparative outcomes and prognosis in patients with ureteral upper tract urothelial carcinoma undergoing segmental ureterectomy versus radical nephroureterectomy: A multicenter cohort study","volume":"111","author":"Yu","year":"2025","journal-title":"Int. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/bju.14697","article-title":"Segmental resection of distal ureter with termino-terminal ureteric anastomosis vs bladder cuff removal and ureteric re-implantation for upper tract urothelial carcinoma: Results of a multicentre study","volume":"124","author":"Abrate","year":"2019","journal-title":"BJU Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"601.e11","DOI":"10.1016\/j.urolonc.2020.03.005","article-title":"Segmental ureterectomy vs. radical nephroureterectomy for ureteral carcinoma in patients with a preoperative glomerular filtration rate less than 90 ml\/min\/1.73 m2: A multicenter study","volume":"38","author":"Abrate","year":"2020","journal-title":"Urol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1089\/end.2024.0654","article-title":"Segmental resection with ureteral reimplantation vs radical nephroureterectomy with bladder cuff removal for urothelial carcinoma of distal ureter: A propensity score matching study in a large Chinese center","volume":"39","author":"Guan","year":"2025","journal-title":"J. Endourol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"330.e11","DOI":"10.1016\/j.urolonc.2025.03.008","article-title":"Pattern and risk factors of local recurrence and intravesical recurrence after segmental ureterectomy for upper tract urothelial carcinoma","volume":"43","author":"Guan","year":"2025","journal-title":"Urol. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"372.e11","DOI":"10.1016\/j.urolonc.2024.05.019","article-title":"Prognostic impact of tumor size in ureteral cancer following segmental ureterectomy","volume":"42","author":"Zhai","year":"2024","journal-title":"Urol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"357.e1","DOI":"10.1016\/j.urolonc.2023.04.013","article-title":"The impact of routine frozen section analysis during nephroureterectomy or segmental ureterectomy for urothelial carcinoma on final surgical margin status and long-term oncologic outcome","volume":"41","author":"Lima","year":"2023","journal-title":"Urol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4593","DOI":"10.1200\/JCO.2022.40.16_suppl.4593","article-title":"Prognostic factors and clinical outcomes in patients with upper tract urothelial carcinoma undergoing surgery: The Cleveland Clinic experience","volume":"40","author":"Ahmed","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3613","DOI":"10.1245\/s10434-012-2453-9","article-title":"Influence of Positive Surgical Margin Status After Radical Nephroureterectomy on Upper Urinary Tract Urothelial Carcinoma Survival","volume":"19","author":"Colin","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.eururo.2012.01.021","article-title":"Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma","volume":"61","author":"Cha","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gao, J., Liu, J., Liu, J., Lin, S., and Ding, D. (2022). Survival and risk factors among upper tract urothelial carcinoma patients after radical nephroureterectomy in Northeast China. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.1012292"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/JU.0000000000000788","article-title":"Differential effect of sex on outcomes after radical surgery for upper tract and bladder urothelial carcinoma: A systematic review and meta-analysis","volume":"204","author":"Mori","year":"2020","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Schultz, A., Jobst, N., Peters, F., Netsch, C., Rosenbaum, C.M., and Filmar, S. (2025). The Impact of Patient, Tumor, and Socioeconomic Characteristics on Survival in Upper Urinary Tract Urothelial Carcinoma (UTUC): A Population-Based Registry Study from Hamburg, Germany (2004\u20132021). Cancers, 17.","DOI":"10.3390\/cancers17172724"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.juro.2013.12.048","article-title":"Preoperative risk factors for extraurothelial recurrence in patients with ureteral cancer treated with radical nephroureterectomy","volume":"191","author":"Ito","year":"2014","journal-title":"J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.urolonc.2019.06.009","article-title":"Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma","volume":"37","author":"Freifeld","year":"2019","journal-title":"Urol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"332.e21","DOI":"10.1016\/j.urolonc.2024.04.001","article-title":"Perioperative renal function change and oncological outcomes of radical nephroureterectomy in patients with upper tract urothelial carcinoma: A multicenter retrospective study","volume":"42","author":"Muramoto","year":"2024","journal-title":"Urol. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/bju.16569","article-title":"The impact of post-nephroureterectomy surgically induced chronic kidney disease on survival outcomes","volume":"135","author":"Puri","year":"2025","journal-title":"BJU Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"662.e9","DOI":"10.1016\/j.urolonc.2025.06.020","article-title":"Oncologic and survival outcomes in patients undergoing radical nephroureterectomy with preoperative or iatrogenic dialysis dependence","volume":"43","author":"Lee","year":"2025","journal-title":"Urol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/j.1464-410X.2012.10960.x","article-title":"Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: Results from a large French multicentre study","volume":"110","author":"Colin","year":"2012","journal-title":"BJU Int."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/15\/2527\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:31:36Z","timestamp":1786163496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/15\/2527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":34,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["cancers18152527"],"URL":"https:\/\/doi.org\/10.3390\/cancers18152527","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}