末期腎病病患發現單側腎臟病灶同時接受雙側腎臟輸尿管切除手術之預後-
臺中榮民總醫院經驗分享
張家程、陳卷書、楊晨洸、王賢祥、李建儀、歐宴泉、裘坤元
臺中榮民總醫院外科部泌尿科
Outcome of ESRD patients with ipsilateral urothelial carcinoma finding received concurrent bilateral nephroureterectomy with bladder cuff excision: VGHTC experience
Chia-Cheng Chang,Chuan-Shu Chen, Cheng-Kuan Yang, Shian-Shiang Wang, Jian-Ri Li, Yen-Chuan Ou, Kun-Yuan Chiu
Taichung Veteran General Hospital, Department of Surgery, Division of Urology
Purpose: Increased urothelial carcinoma(UC) has been reported in end-stage renal disease (ESRD). The incidence of UC was significantly higher in the HD patients in upper urinary tract (UTUC) and bladder (UBUC). The most common manifestation is painless gross hematuria. Nephroureterectomy with bladder cuff excision was the standard treatment when UTUC was diagnosed. However, further following up of contra-lateral site was suggested under the increased risk of metachronous UTUC. As a result, we would like to evaluate whether patients may benefit from concurrent bilateral nephroureterectomy.
Materials and Methods: We enrolled the patients with ESRD under H/D or P/D diagnosed with UTUC from 2008 to 2015 at Taichung Veteran Hospital. Total 53 patients received nephroureterectomy with bladder cuff excision as cancer treatment. 21 patients received concurrent contra-lateral nephrectomy with bladder cuff excision at the same time. We calculate the overall survival rate and cancer specific survival rate whether ESRD patient may benefit from bilateral nephroureterectomy.
Results: Among the all patients, 32 patients received ipsilateral nephroureterectomy with bladder cuff excision while 21 patients received concurrent bilateral nephewroureterectomy. There was no difference such as age, BMI, gender, performance status(ECOG) between the two groups. The tumor characteristics such as tumor T staging, tumor grading, margin finding and lympho-vascular involvement revealed no significant difference.
After following up the patients for 5 years, 8 patients died in unilateral group(32 cases) while 7 patients died in bilateral groups(21 cases). The overall survival rates appeared no significant difference, 93.5% 5 years survival rate in unilateral group and 65.9% in bilateral group with p=0.385. If we focus on cancer disease(urothelial carcinoma), 4 people died of cancer in unilateral group while 1 person died of cancer in bilateral group. The cancer specific rates appeared no significant difference, 84.2% 5 years survival rate in unilateral group and 93.3% in bilateral group with p=0.477.
Conclusion: Among the limited study population, concurrent bilateral nephroureterectomy with bladder cuff excision did not appear superior outcome over ipsilateral nephroureterectomy. If ESRD patients encountered urothelial carcinoma diagnosis, both ipsilateral and concurrent bilateral nephroureterectomy with bladder cuff excision were acceptable choice for them on the oncologic control.