Upper urinary tract urothelial carcinoma (UTUC) is a relatively rare malignancy, accounting for 5% to 10% of all urothelial cancers [1]. Preoperative stratification of UTUC into low- or high-risk of progression, determines the therapeutic strategy [2]. According to available evidence, kidney-sparing surgery (KSS) is a recommended option for low-risk tumors, with expected oncological outcomes comparable to radical nephroureterectomy (RNU) [3]. For high-risk tumors, irrespective of their primary location, RNU is the treatment of choice, although distal ureter tumors might be treated with segmental ureterectomy (SU) [2,4]. Simultaneously, KSS is a viable option for patients with a solitary kidney or severe renal failure, even in cases of high-risk UTUC. Nevertheless, strong evidence supporting the utility of KSS for ureteral and renal pelvis UTUCs is still lacking. Noteworthy, KSS has been associated with better preservation of renal function and lower overall morbidity [2,5].

Kidney-sparing modalities include SU and rigid or flexible ureterorenoscopy (URS) with tumor ablation. The inferiority of the endoscopic KSS is related to the risk of incomplete tumor removal and a significant risk of pathological understaging due to poor sampling [6,7]. On the other hand, this limitation is not applicable to SU, which primarily aims at wide-margin tumor resection and provides excellent cancer control [5].

Considering the limited real-world population-based data on the efficacy and long-term oncologic outcomes of KSS in patients with low- and high-risk UTUC, our aim was to compare the overall survival (OS) and cancer-specific survival (CSS) between patients who underwent KSS and RNU for UTUC.