根除性腎臟輸尿管切除術控制結果之群組分析 : 單一醫學中心經驗
許家豪1、林宜佳 1,2、蔡德甫1,2、黃一勝 1,2,3
1新光吳火獅紀念醫院泌尿科; 2天主教輔仁大學醫學系泌尿科; 3台北醫學大學泌尿科
Subgroup analysis of outsomes of radical nephroureterectomy: a single institution experience
Chia-Hao Hsu1, Yi-Chia Lin1,2, Te-Fu Tsai1,2 and Thomas I.S. Hwang1,2,3
1 Division of Urology, Department of Surgery, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan
2 Department of Urology, Fu Jen Catholic University School of Medicine, Taipei, Taiwan, ROC
3 Department of Urology, Taipei Medical University, Taipei, Taiwan
Open, hand-assisted laparoscopy and pure laparoscopy technique are now cornerstones of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We aimed to perform subgroup analysis about the outcomes and complications of patient with UTUC receiving RNU at our institution.
Materials and Methods:
Patient with UTUC receiving RNU from 2004 to 2014 at Shin-Kong WHS Memorial Hospital were included. Relevant demographic and perioperative data during and within 6 weeks of surgery were evaluated retrospectively. Subgroup analysis comparing these three method was also performed.
A total of 138 RNU were performed. Open approach resulted in more blood loss (715 +/- 617 mls). Pure-laparoscopic consumed more operative time (193 +/- 78 mins) and Hand-assisted approach resulted in less length of stay (8.7 +/- 4.0 days). Pathological stage 4 cancer resulted in more blood loss, more operative time, and longer length of stay. However, grade did not resulted in statistically different perioperative outcome. At a median follow-up of 65mons, OS and PFS revealed a better result toward pure laparoscopic RNU. The limitations of our study include the small sample size, the single-centre experience, the personal choice of laparoscopic technique. Comparing the periods of 2004 to 2009 vs 2010 to 2014, the incidence of complications tended to decrease (17.3% vs 12.5%, p=0.3).
Pure-laparoscopic and hand-assisted RNU are seemed safe techniques for patient with UTUC. In our institution, robotic-assisted laparoscopic RNU still make progress.