Distal ureterectomy versus radical nephroureterectomy for nonmetastatic distal ureteral urothelial carcinoma - a GRADE-assessed systematic review and meta-analysis of comparative studies

Sep 22, 2026

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Oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains uncertain, especially when renal preservation is clinically desirable. A systematic review and meta-analysis searched multiple databases from inception to February 27, 2026, including six comparative studies with 1,247 patients. Primary outcome was positive surgical margin, with DU showing no significant differences for margin positivity, cancer-specific survival, lymph node metastasis, muscle-invasive disease, or high-grade burden; intravesical recurrence may be higher after DU.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Keywords

Introduction

Mirza et al. World Journal of Surgical Oncology (2026) 24:313 [https://doi.org/10.1186/s12957-026-04438-9](https://doi.org/10.1186/s12957-026-04438-9) World Journal of Surgical Oncology REVIEW Open Access Distal ureterectomy versus radical nephroureterectomy for nonmetastatic distal ureteral urothelial carcinoma: a GRADEassessed systematic review and meta-analysis of comparative studies Wajahat Mirza1*, Khalid Hussain2, Maria Khalid2, Rao Nouman Ali3, Muhammad Bilal Moeen-Ud-Din4 and Abdalla M. Hadhoud4 Abstract Background The oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal preservation is clinically desirable. Methods A systematic review and meta-analysis of comparative studies was performed. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 27, 2026. A total of 229 records were identified, 14 full-text articles were assessed, and 6 studies were included. The primary outcome was a positive surgical margin. Secondary outcomes included intravesical recurrence, cancer-specific survival, lymph node metastasis, muscle-invasive disease (≥ pT2), and high-grade pathologic disease burden as a marker of baseline oncologic risk and treatment-selection balance. Random-effects models were used. Risk of bias was assessed with ROBINS-I, and certainty of evidence was evaluated using GRADE. Results A total of 6 comparative studies comprising 1,247 patients were included, of whom 588 underwent distal ureterectomy, and 659 underwent radical nephroureterectomy. DU was not associated with a significant difference in positive surgical margin compared with RNU (RR 1. 24, 95% CI 0.64–2.43) . Cancer-specific survival was also comparable (HR 0 . 97, 95% CI 0.72–1. 29) . No significant differences were observed for lymph node metastasis (RR 0 . 85, 95% CI 0.40–1. 80), muscle-invasive disease (RR 0 . 96, 95% CI 0 .86–1. 08), or high-grade disease (RR 0 . 97, 95% CI 0.86–1. 09) . Intravesical recurrence was not significantly different in the primary pooled analysis (HR 1. 36, 95% CI 0.89–2. 07), although sensitivity analysis suggested a higher recurrence hazard after DU. Most outcomes were supported by very low to low certainty evidence. *Correspondence: Wajahat Mirza [wajahatmirza.clinicalresearch@gmail.com](wajahatmirza.clinicalresearch@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Mirza et al. World Journal of Surgical Oncology (2026) 24:313 Page 2 of 15 Conclusions In selected patients with nonmetastatic distal ureteral urothelial carcinoma, DU appears to preserve oncologic adequacy relative to RNU while offering a kidney-sparing surgical alternative

FAQs

What clinical question does this review address?

It compares DU and RNU for patients with nonmetastatic distal ureteral urothelial carcinoma, focusing on whether DU provides adequate oncologic outcomes when renal preservation is prioritized.

How were studies selected and assessed in the meta-analysis?

Comparative studies were identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library through February 27, 2026. Risk of bias was assessed with ROBINS-I and certainty of evidence was evaluated using GRADE.

What were the main findings comparing DU with RNU?

DU was not associated with significant differences in positive surgical margin, cancer-specific survival, lymph node metastasis, muscle-invasive disease, or high-grade disease. Intravesical recurrence was not significantly different in the primary analysis, but sensitivity analysis suggested a higher recurrence hazard after DU.

Sep 22, 2026

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