MP036: Oncologic outcomes of robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper urinary tract urothelial carcinoma
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  • 2017-12-25,
  • 上傳者: TUA秘書處,
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達文西機器手臂輔助腎臟輸尿管切除手術於泌尿上皮癌之預後
賴谷順1、歐宴泉2
1台中榮民總醫院外科部泌尿科 ; 2童綜合醫院外科部泌尿科
Oncologic Outcomes of Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma
Gu-Shun Lai1、Yen-Chuan Ou2
1Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan ;
2Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital
 
Purpose
To report the intermediate-term oncologic outcomes of robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for the management of upper urinary tract urothelial carcinoma.
Materials and Methods:
We reviewed 43 patients who had received robot-assisted laparoscopic nephroureterectomy with bladder cuff excision in our hospital for the treatment of their upper urinary tract urothelial carcinoma over an approximately 5 years period (November 2010 to June 2016). Operations were performed by one surgeon using the single-docking method. We analyzed their personal characteristics, peri-operative data, pathology results and oncology outcome.
Results
The mean patient age was 71.4 years. The final pathologic results revealed Ta in 4.7% of patients (n = 2), T1 in 30.2% (n = 13), T2 in 11.6% (n = 5), T3 in 39.5% (n = 17), and T4 in 9.3% (n = 4). Median follow-up duration was 33 months (range, 6 to73). At two and five years, overall survival rate was 86.7% and 72.3%, cancer specific survival rate was 89.9% and 74.9%, and recurrence free survival rate was 70.9% and 53.2%, respectively. On univariate analysis, male gender (p=0.04), stage T3/T4 tumor (p=0.025), history of and/or concurrent urinary bladder tumor (p=0.023) and impaired renal function (creatine > 2 mg/dl) (p=0.002) were significantly associated with the lower recurrence-free survival rate. Multifocal disease was associated with decreased cancer specific survival (p = 0.018). However, no factors were associated with poorer survival on multivariate analysis.
Conclusion
For upper urinary tract urothelial carcinoma, robot-assisted laparoscopic nephroureterectomy with bladder cuff excision was comparable in terms of the intermediate-term oncologic outcomes when compared with the open and laparoscopic approach. Long-term follow-up studies with larger sample size will be required to determine definitively the role of robot-assisted approach.
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    資料夾 :
    發表時間 :
    2017-12-25 14:14:03
    觀看數 :
    276
    發表人 :
    TUA秘書處
    部門 :
    台灣泌尿科醫學會
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