腎元保留手術於遠端輸尿管惡性腫瘤之治療經驗
李彥羲、陳毓騏、林嘉祥、余燦榮、王華斌、江朝洋、林鴻裕、盧嘉文、黃景榆
義大醫療財團法人義大醫院泌尿部
義守大學
Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single center experience
Yen-Hsi, Lee, Yu-Chi Chen, Victor C. Lin, Tsan- Jung Yu, Hua-Pin Wang, Chao-Yang Jiang, Hung-Yu Lin, Kelvin Lu, Ching-Yu Huang
Department of Urology, E-DA Hospital, Taiwan
I-Shou University, Taiwan
Purpose: Radical nephroureterectomy (NU) with bladder-cuff excision has been the traditional treatment for UTUC because of its high rate of recurrence. However, given the morbidity of nephrectomy and the risk of developing chronic kidney disease (CKD) or dialysis-dependent renal failure, a nephron-sparing approach may be preferable in selected patients.
Materials and Methods: We retrospectively analyzed 19 patients from March 2006 to December 2014 at single center in Southern Taiwan who underwent distal ureterectomy with reimplantation of ureter and confirmed to be ureter malignancy (urothelial carcinoma n=18, squamous cell carcinoma n=1) on final pathology. Outcome measures were recurrence or distant metastasis, renal function preservation, time to recurrence and overall survival.
Results: Total 19 patients, 13 males, 6 females, and mean age are 69.3 years old. There are no local recurrence, 9 bladder recurrence (47.4%), 3 distant metastasis (15.8%), and 2 progression to radical nephroureterectomy (10.5%). Pathological staging: Tis n=1, Ta n=3, T1 n=2, T2 n=6, T3 n=5. Low grade n=3, high grade n=12. Mean time to recurrence was 12.4 (3-24) months, and mean follow up time was 28.1 (1-90) months. Overall survival rate is 73.7% (14/19), among them, 4 lost follow up, 1 expired. Mean pre-op creatinine was 1.61 mg/dl, 1 yr post operation creatinine was 1.56mg/dl.
Conclusion: Distal ureterectomy with reimplantation surgery in our experience is a feasible option for distal ureter tumor in selected patients (chronic kidney disease, solitary kidney). Favorable post-operative outcomes with low local recurrence rate, low rate of progression to NU and renal function preservation are the benefits.