上泌尿道尿路上皮癌之病人在腎臟輸尿管切除後的腎功能改變
方仁愷、蕭博任、張議徽、張兆祥、黃志平、楊啟瑞、陳汶吉、葉進仲、連啟舜、陳冠亨、吳錫金、謝博帆、李宗睿、張英傑
中國醫藥大學附設醫院 泌尿部
Changes in Renal Function after Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma
Jen Kai Fang, Po-Jen Hsiao, Yi-Huei Chang, Chao-Hsiang Chang, Chi-Ping Huang, Chi-Rei Yang, Wen-Chi Chen, Chin-Chung Yeh, Chi-Shun Lien, Guang-Heng Chen, Hsi-Chin Wu, Po-Fan Hsieh, Tzung-Ruei Li, Ying-Chieh Chang
Department of Urology, China Medical University Hospital
Purpose: Nephroureterectomy with bladder cuff excision(NUBCE) is the standard treatment of upper tract urothelial carcinoma(UTUC). The postoperative renal function impacts on the survival and quality of life. Renal function deterioration may make adjuvant chemotherapy ineligible and ESRD develop. The aim of this study was to analyze the changes in renal function after NUBCE.
Materials and Methods: From December 2011 to August 2018, we retrospectively reviewed patients with UTUC who underwent NUBCE. Patients with preoperative end-stage renal disease(ESRD) or lost follow-up were excluded. The serum creatinine and eGFR of preoperative and 3 months after the surgery were recorded. The time to long-term hemodialysis was also mentioned.
Results: 296 patients were included in analysis. More decline of renal function developed in the better baseline renal function patients. (Preoperative eGFR: >90, 60-90, 30-60, 15-30, <15 ml/min/1.73m2, median change of eGFR: -43, -21, -7, -4, 0 ml/min/1.73m2, respectively). 20 patients (6.7%) developed ESRD during the median follow time of 28 months. 7 of the patients received contralateral nephroureterectomy due to UTUC recurrence. The 13 patients without contralateral surgery developing ESRD had preoperative stage 5 chronic kidney disease(CKD). The median time to long-term hemodialysis was 7.6 months. On the other hand, 45 patients (15.2%) had the postoperative eGFR >60 ml/min/1.73m2. The median preoperative eGFR was 83 ml/min/1.73m2 (range 45-150 ml/min/1.73m2).
Conclusions: Changes in renal function after unilateral nephroureterectomy are limited in CKD patients. Seldom patients with preoperative eGFR >15 ml/min/1.73m2 need hemodialysis postoperatively. Furthermore, some patients’ postoperative renal function was better than preoperative. Even if the preoperative eGFR is 45 ml/min/1.73m2, he/she may have the chance of adjuvant cisplatin-based chemotherapy.