Surgical Treatment of Platinum-Resistant Recurrent Urothelial Carcinoma: A Case Report and Review

Patients with upper urinary tract urothelial carcinoma often develop aggressive recurrences even after radical surgery, with reported recurrence rates ranging from 6.2% to 33%. This article presents a review on the topic and a clinical case of surgical treatment of platinum-resistant recurrent urothelial carcinoma. A 52-year-old male patient underwent right laparoscopic nephroureterectomy with resection of the right ureteral orifice due to a 1.5 cm tumor of the lower third of the right ureter complicated by hydronephrosis. Histological examination revealed a non-invasive papillary urothelial carcinoma of the ureteral mucosa, G2, pTa, with negative resection margins. No malignant cells were detected in the removed lymph nodes. Seven months later, the patient was diagnosed with a large recurrent tumor in the right posterolateral pelvis with signs of invasion into the bladder wall and sigmoid colon, which was resistant to platinum-based chemotherapy and lacked PD-L expression. Repeat surgery was performed, including radical cystoprostatevesiculectomy with Bricker ileal conduit, obstructive anterior resection of the rectum, and sigmoidostomy. Histological analysis revealed recurrent urothelial carcinoma of the right ureter with invasion into the prostate, bladder, and large intestine. Tumor regression was minimal. Resection margins of the intestine and ureter were free of tumor. Given the extent of the recurrent tumor and lack of response to standard chemotherapy, the patient was prescribed immunotherapy with pembrolizumab, which resulted in no further disease progression. A rare clinical case of treatment of advanced platinum-resistant recurrent urothelial carcinoma with long-term remission following surgical intervention is presented. This case describes the aggressive course of non-invasive urothelial carcinoma despite high-grade tumor differentiation.