Introduction:Urothelial carcinoma is the fourth most common solid malignancy1 in the world. The majority (90– 95%) of cases occur in the lower urinary tract (urinary bladder and urethra) and the rest in the upper urinary tract (renal calyces, renal pelvis, and ureter).2 The management of Upper urothelial malignancy is nephroureterectomy with bladder cuff excision. This Case seriesreviewed the patients treated in a tertiary care and analyzed systematically regarding management. Case series: Upperurothelial tract carcinoma (UUTC) admitted and operated at government Royapettah hospital, Chennai, Tamilnadu for the past 4 years were taken and reviewed. There were 4 cases were operated in our hospital. Average age at diagnosis was 50.6 yrs. All four patients were males. All patients were evaluated by contrast enhanced CT scan. Cystoscopy done routinely for all cases and found no synchronous bladder cancer. All patients underwent laparoscopic assisted nephroureterectomy with open resection of distal ureter with bladder cuff margin. Among these one patient had microscopic margin positive at bladder cuff and treated with radiation. Discussion: Renal pelvis UTUCs are twice as common as those found in the ureter.4 In terms of staging, 60% of UTUCs are invasive (≥pT2) at diagnosis in contrast to the 15–25% for bladder cancers.5 About 7% of patients present with metastatic disease.6 Regarding imaging CT urogram has become the standard of care. The gold standard of treatment for patients with upper tract urothelial neoplasms and a normal contralateral kidney is complete nephroureterectomy with removal of a cuff of urinary bladder. A retroperitoneal lymph node dissection along the ipsilateral great is performed for more complete surgical staging, especially for higher grade and invasive cancers. A lymphadenectomy may not be necessary in cases of UTUC which are low stage and low grade. In our case series, Average operating time was 142 min. Average blood loss was 240 ml. All patients had decreased analgesia frequency (mean 2.1 days), faster return to ambulation (mean 1.5 days), with mean hospital stay of 8 days. In our institute we resected the distal ureter with bladder cuff excision by open technique. Conclusion: In summary, laparoscopic nephroureterectomy with open bladder cuff excision was a safe and acceptable alternative to open nephroureterectomy with bladder cuff excision. Cancer control rates seem to be similar with superior convalescence, but need follow up and large no of cases to mention about recurrence. In terms of managing the distal ureter and bladder cuff, the open technique is the most efficacious in terms of achieving negative margins and decreased risk of cancer seeding.

Keywords: Upper urothelial tract carcinoma; Nephroureterectomy with bladder cuff removal.