上泌尿道泌尿上皮癌症接受手輔助腹腔鏡腎臟輸尿管切除術後，殘存膀胱袖口與否不影響病人存活率
陳育典 楊文宏 歐建慧
成功大學附設醫院泌尿科
Leaving residual ureteral orifice after hand-assisted retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer is less time consuming and do not affect overall survival
Yu-Dan Chen, Wen-Horng Yang, and Chien-Hui Ou
Department of Urology, National Cheng-Kung University Hospital, Medical College, National Cheng-Kung University, Tainan, Taiwan
Purpose:
To determine the impact of residual ureteral orifice after hand-assisted retroperitoneoscopic nephroureterectomy (HARN) for primary upper tract urothelial cancer. (UTUC)
Methods:
We retrospectively reviewed patients with upper UTUC that had undergone HARN. Of these 75 patients, 37 of which belonged to the study group with ipsilateral residual ureteral orifice (RUO) due to difficult operative approach (because of obesity, previous pelvic operation or radiation therapy, etc), while 38 patients served as controls with no residual ureteral orifice (NUO) postoperatively by follow up cystoscopy. We analyzed intravesical recurrence, local recurrence, and survival to assess the significance between two groups.
Results:
Baseline demographics were comparable in both groups. In comparison with the RUO group, the NUO group was associated with a longer total operative time (150±78 vs.200±115 mins, p=0.03). Bladder recurrence was observed in 22 out of 37 (59.5%) in the RUO group and in 10 out of 38 (26%) in the NUO group (p=0.001) during median 39.7 months follow up. There was a significant difference in bladder cancer recurrence-free rate in the NUO group versus RUO group (p=0.04). Forty-eight percent (24/50) of first intravesical recurrence had a tendency of recurrence occurring near the area of ipsilateral ureteral orifice/scar especially in RUO group. (57.5% vs.40 %, p= 0.04). Most patients (94%) in whom a bladder tumor developed postoperatively were superficial and underwent transurethral resection of the bladder tumor. The survival rate was not significantly different when we compared the RUO and NUO groups (p =0.42).
Conclusion:
Leaving residual ureteral orifice is less time consuming, although increase the risk of intravesical recurrence, did not undermine survival after HARN for primary UTUC.