腹腔鏡及機器手臂腎輸尿管切除術用於第三四期尿路上皮癌的預後比較
李宗叡、張議徽、張兆祥、黃志平、楊啟瑞、陳汶吉、吳錫金
中國醫藥大學附設醫院 泌尿部
Outcomes of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with T3 and T4 Upper Tract Urothelial Carcinoma in CMUH
Tzung-Ruei Li, Yi-Huieh Chang, Chao-Hsiang Chang, Chi-Ping Huang, Chi-Rei Yang, Wen-Chi Chen, His-Chin Wu
Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose: The aim of this study is to compare the oncological and perioperative outcomes of two different nephroureterectomy approaches in patients with upper tract urothelial carcinoma(UTUC) in T3 and T4 group

Materials and Methods:

Our cohort recruited 143 patients between 2011 to 2018 who was diagnosed with UTUC T3 and T4, received laparoscopic and robotic assisted nephroureterectomy. Perioperative and postoperative survival outcomes were compared. All statistical analysis was performed with SPSS 22.0, including the Kaplan-Meier analysis.

Results: Of the patients, 97 and 46 were treated with laparoscopic and robotic approach, respectively. 50 patients received chemotherapy first. The patient characteristic showed no significantly difference. Margin positive was observed in 7.2% of laparoscopic group and 13.0% of robotic group. There was no significant differences in post-operative complication (laparoscopic 21.6%, robotic 35.8%;p=0.119). The average recurrence-free (UT recurrence, lymph nodes recurrence and distant recurrence) survival months in laparoscopic and robotic approach groups were 48 and 35. The average overall survival months in laparoscopic and robotic approach groups were 53 and 48. OS, RFS and cancer-specific survival all showed no significantly different on Kaplan-Meier analysis.

Conclusions:

Our cohort study showed that laparoscopic and robotic approach for high grade like T3 and T4 had acceptable outcomes, including overall survival, cancer-free survival and recurrence-free survival, with well-trained surgeon. Further large cohort may need to confirm the feasibility of robotic and laparoscopic approach to high grade UTUC in Taiwan population.