針對上泌尿道泌尿上皮癌之膀胱袖狀切除，不同手術方式的相互比較

吳冠儒、曾仁澍

台北馬偕紀念醫院 泌尿科

Comparison of Bladder Cuff Excision Method in UTUC

Kuan-Ju Wu ⁽¹⁾, Jen-Shu Tseng * ^(1)(2)(3)(4)

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan ⁽¹⁾

Kaomei Urologic Clinic, Banqiao, New Taipei City, Taiwan ⁽²⁾

Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan ⁽³⁾

School of Medicine, MacKay Medical College, New Taipei City, Taiwan ⁽⁴⁾

Purpose:

To determine the most effective technique for bladder cuff excision (BCE) in treating upper urinary tract urothelial carcinoma (UTUC).

Materials and Methods:

We conducted a retrospective analysis of 1172 UTUC patients across nineteen hospitals in Taiwan between July 1988 and August 2022, focusing on surgeries performed from January 11, 2001, to November 22, 2021. Patients were divided into three groups: open incision, transurethral, and laparoscopic (LPS)/robotic/laparoendoscopic single-site surgery (LESS). The open incision group comprised 1056 patients, while the remaining patients were divided among the other techniques.

Results:

Univariate analysis revealed that LPS/Robotic/LESS resulted in better overall survival (OS) compared to open incision (HR=0.612, 95% CI 0.448-0.836, p=0.002). In terms of bladder recurrence free survival (BRFS), the transurethral group showed a lower bladder recurrence rate than the open incision group (HR=0.697, 95% CI 0.505-0.961, p=0.028). However, multivariate analysis indicated that the transurethral method had worse outcomes than open incision for cancer-specific survival (HR=2.347, 95% CI 1.115-4.942, p=0.025) and disease-free survival (HR=1.831, 95% CI 1.079-3.108, p=0.025). Surprisingly, the transurethral group showed better bladder-recurrence free survival (HR=0.606, 95% CI 0.414-0.888, p=0.01).

Conclusion:

The transurethral method shows a lower bladder recurrence rate, but open incision and laparoscopic techniques also offer benefits, including improved CSS and DFS. The laparoscopic approach, with superior overall survival, is recommended as the primary option.