腎細胞癌手術治療時是否需同時切除輸尿管？
徐慧興，莊恆彰，張世琦，王旭翔， 邵逸宏
羅東博愛醫院 外科部 泌尿科
Is there necessary to perform ureterectomy in renal cell carcinoma treatment
Hueih-Shing Hsu, Heng-Chang Chuang, Shyh-Chyi Chang, Hsu-Hsiang Wang, I-Hung Shao
Division of Urology, Department of Surgery, Lotung Pohai Hospital Yilan, Taiwan
Purpose: Radical nephrectomy is the standard surgical treatment of localized renal cell carcinoma.
Is there necessary to perform ureterectomy at the same time? We challenge this question, because we have tow cases of renal cell carcinoma received radical nephrectomy but recurrent tumor was found in the ureter several years later.
Case 1: This is a 79 years old man who received left radical nephrectomy for renal cell carcinoma stage (T2N0M0) 4 years ago. And he underwent hemodialysis for end stage renal disease for 5 years. Gross hematuria was noted recently and CT scan showed left ureter tumor in the remaining stump. Ureterectomy with bladder cuff was done and pathology shoed transitional cell carcinoma stage T3NoMo.
Case 2: This is a 90 years old man who received left radical nephrectomy for renal cell carcinoma (stage T3N0M0 )14 years ago. He suffered from gross hematuria and CT showed left ureter tumor in the stump. Ureterectomy with bladder cuff was done and pathology shoed renal cell carcinoma stage T4N1Mo.
Discussions: Renal cell carcinoma is not only existed in renal parenchyma but also in collecting system. Transitional cell carcinoma may occured in the remaining stump of ureter in uremia patient. So it is better to perform ureterectomy in uremia patient or the larger renal tumor closed to renal pelvis.