腎輸尿管切除術在上尿路尿路上皮癌患者循環腫瘤細胞的影響

江佩璋、高建璋^1,2、查岱龍^1,2、吳勝堂¹、蒙恩¹、曹智惟¹、陳進利¹、孫光煥¹、于大雄¹、張聖原¹、楊明昕^1,2

¹三軍總醫院 外科部 泌尿外科；²國防醫學院 醫學科學研究所

Effect of nephroureterectomy on circulating tumor cells in patients with upper urinary tract urothelial carcinoma

Pei-Jhang Chiang¹, Chien-Chang Kao^1,2, Tai-Lung Cha^1,2, Sheng-Tang Wu¹, En Meng¹, Chih-Wei Tsao¹, Chin-Li Chen¹, Guang-Huan Sun¹, Dah-Shyong Yu¹, Sun-Yran Chang¹, Ming-Hsin Yang^1,2

¹Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense

Medical Center, Taipei, Taiwan

²Graduate School of Medical Sciences, National Defense Medical Center, Taipei, Taiwan

Objective:

To compare perioperative circulating tumor cells (CTC) in primary upper tract urothelial carcinoma (UTUC) patients who underwent hand-assisted retroperitoneoscopic nephroureterectomy (HANU) or robotic-assisted nephroureterectomy (RANU).

Methods:

A total of 29 patients received RANU (n = 10) or HANU (n = 19). Peripheral blood samples were collected before, 24 hours after surgery (POh24) and on postoperative day 28 (POD28). CTCs were enriched based on cell surface marker and filtration through IsoFluxTM device, followed by identification according to cell morphology and immunofluorescence studies.

Results:

The demographic and pathologic data are similar in both groups. RANU had a longer operative time (p = 0.031), less bleeding volume (p = 0.004), and comparable pain sore (p = 0.169). The mean CTC numbers before surgery (2.4 versus 2.3, p = 0.482), POh24 (2.4 versus 1.9, p = 0.668) and POD28 (0.5 versus 0.6, p = 0.280) were not significant different among groups. The number of CTCs in both groups decreased and reached similar level on POD28. No significant difference of overall and intravesical recurrence rate between the two approaches.

Conclusions:

In comparison to RANU, more surgical manipulation does not affect tumor cell translocation into the bloodstream in UTUC patients who received HANU. However, a longer follow-up would be needed for the final comparison of tumor recurrence.