手術經驗是否影響台灣原發性上泌尿道泌尿上皮癌接受腹腔鏡或手輔式腹腔鏡腎輸尿管切除術之結果

郭致均^1,5、陳冠亨^2,3、張兆祥^2,4、黃昭淵^5,6、陳忠信⁵、李經家^7,8,9、吳文正^7,8,9、游智欽^10,11、羅啟文¹⁰、陳永泰¹²、陳欣宏¹²、鍾旭東^13,14、鄭百諭¹³、薛又仁^{15, 16}、邱文祥¹⁷、蔡曜州^18,19、顧芳瑜¹⁸、曾仁澍^20,21,22、林仁泰²³、江元宏²⁴、吳佳璋^25,26,27、林威宇^28,29,30、黃旭澤^1,31、江漢聲^1,31、姜秉均^1,32,33

¹天主教耕莘醫院 外科部泌尿科、²中國醫藥大學附設醫院泌尿部、³中國醫藥大學新竹附設醫院泌尿科、⁴中國醫藥大學醫學系、⁵國立台灣大學附設醫院 泌尿部、⁶國立台灣大學醫學院、⁷高雄醫學大學附設中和紀念醫院泌尿部、⁸高雄醫學大學醫學系泌尿學科、⁹高雄醫學大學臨床醫學研究所、¹⁰佛教慈濟醫療財團法人台北慈濟醫院外科部泌尿科、¹¹花蓮慈濟大學醫學院、¹²基督復臨安息日會醫療財團法人臺安醫院泌尿科、¹³醫療財團法人徐元智先生醫藥基金會亞東紀念醫院外科部泌尿科、¹⁴元智大學生物與醫學資訊研究所、¹⁵台北市立聯合醫院外科部泌尿科、¹⁶國立陽明交通大學醫學系泌尿學科、¹⁷國立陽明交通大學醫學院、¹⁸台北醫學大學醫學院醫學系泌尿學科、¹⁹台北醫學大學附設醫院泌尿科、²⁰台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院泌尿科、²¹馬偕學校財團法人馬偕醫學院、²²國立陽明交通大學生物醫學資訊研究所、²³高雄榮民總醫院泌尿外科、²⁴佛教慈濟醫療財團法人花蓮慈濟醫院泌尿部、²⁵衛生福利部雙和醫院泌尿科、²⁶台北醫學大學醫學院醫學系泌尿科、²⁷臺北醫學大學泌尿腎臟研究中心、²⁸長庚醫療財團法人嘉義長庚紀念醫院泌尿科、²⁹嘉義長庚學校財團法人長庚科技大學、³⁰長庚大學醫學系、 ³¹天主教輔仁大學附設醫院泌尿科、³²天主教輔仁大學醫學院、³³國立台灣師範大學生命科學院

Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy from Taiwan upper urinary tract urothelial carcinoma database

Chih-Chun Kuo^1,5, Guang-Heng Chen^2,3, Chao-Hsiang Chang^2,4, Chao-Yuan Huang^5,6, Chung-Hsin Chen^5,6, Ching-Chia Li^7,8,9, Wen-Jeng Wu^7,8,9, Chih-Chin Yu^10,11, Chi-Wen Lo¹⁰, Yung-Tai Chen¹², Shin-Hong Chen¹², Shiu-Dong Chung^13,14, Pai-Yu Cheng¹³, Thomas Y. Hsueh^15,16, Allen W. Chiu¹⁷, Yao-Chou Tsai^18,19, Fang-Yu, Ku¹⁸, Jen-Shu Tseng^20,21,22, Jen-Tai Lin²³, Yuan-Hong Jiang²⁴, Chia-Chang Wu^25,26,27, Wei-Yu Lin^28,29,30, Hsu-Che Huang^1,31, Han-Sun Chiang^1,31, and Bing-Juin Chiang^1,32,33

¹Department of Urology, Cardinal Tien Hospital. ²Department of Urology, China Medical University and Hospital. ³Department of Urology, China Medical University Hsinchu Hospital. ⁴School of Medicine, China Medical University. ⁵Department of Urology, National Taiwan University Hospital. ⁶College of Medicine, National Taiwan University. ⁷Department of Urology, Kaohsiung Medical University Hospital. ⁸Department of Urology, School of Medicine, Kaohsiung Medical University. ⁹Graduate Institute of Clinical Medicine, Kaohsiung Medical University. ¹⁰Division of Urology, Department of surgery, Taipei Tzu Chi Hospital. ¹¹School of Medicine, Buddhist Tzu Chi University. ¹²Department of Urology, Taiwan Adventist Hospital. ¹³Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital. ¹⁴Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University. ¹⁵Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch. ¹⁶Department of Urology, School of Medicine, National Yang Ming Chiao Tung University. ¹⁷College of Medicine, National Yang Ming Chiao Tung University. ¹⁸Department of Urology, School of Medicine, College of Medicine, Taipei Medical University. ¹⁹Department of Urology, Taipei Medical University Hospital, Taipei Medical University. ²⁰Department of Urology, MacKay Memorial Hospital. ²¹Mackay Medical College. ²²Institute of Biomedical Informatics, National Yang Ming Chiao Tung University. ²³Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital. ²⁴Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University. ²⁵Department of Urology, Shuang Ho Hospital, Taipei Medical University. ²⁶Department of Urology, School of Medicine, College of Medicine, Taipei Medical University. ²⁷TMU Research Center of Urology and Kidney, Taipei Medical University. ²⁸Division of Urology, Department of Surgery, Chang Gung Memorial Hospital. ²⁹Chang Gung University of Science and Technology.

³⁰Department of Medicine, Chang Gung University. ³¹Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University. ³²School of Medicine, Fu-Jen Catholic University. ³³Department of Life Science, College of Science, National Taiwan Normal University.

Purpose:

Taiwan has a high incidence of upper tract urothelial carcinoma (UTUC), but no single method of laparoscopic nephroureterectomy (LNU) has been proven for the best oncological outcome and most patients are concentrated at tertiary centers. Thus, we conducted a multi-institute retrospective study to evaluate the influence of surgical experience on oncological outcomes following transperitoneal pure laparoscopic NU (TP-LNU) and transperitoneal hand-assisted LNU (TP-HALNU) in the Taiwanese population.

Materials and Methods:

Our research group enrolled 14 hospitals in Taiwan and acquired a UTUC patient database from the Taiwan Cancer Registry. We retrospectively reviewed patient records between July 1988 and September 2020, of which 622 patients received LNU. A total of 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncologic outcomes were compared.

Results:

Of the 322 patients, 181 and 141 patients received TP-LNU and TP-HALNU, respectively. There were no differences in the clinical and histopathological data between the two groups. TP-HALNU showed a slightly higher overall mortality rate, but no differences were observed in perioperative and postoperative complications. The two approaches showed no differences in oncological outcomes. Age > 70 years, positive pathological lymph metastasis, and tumors located in the upper ureter were predictive factors associated with an increased risk of oncological outcomes. Female sex was the sole protective factor for oncological outcomes. Hospitals with surgical experience over 20 cases showed lower risk on overall survival.

Conclusion:

Hospitals with surgical experience over 20 cases are qualified for patients with UTUC to receive laparoscopic nephroureterectomy. No significant difference in oncological outcomes was seen between TP-LNU and TP-HALNU; perioperative and postoperative complication rates were also comparable. Age, sex, lymph node metastasis, and tumor in the upper ureter were predictive factors for oncological outcomes.