部分膀胱切除手術在泌尿科學的執行：單一醫學中心之經驗
蔡佳穆1、陳逸軒1,2、陳盈伸1、林仁泰1、蔡政諭1、余家政1,2,3、吳東霖1
1高雄榮民總醫院外科部泌尿外科
2國防醫學中心三軍總醫院外科部泌尿外科
3大仁科技大學藥學系
Partial Cystectomy in Urological Practice: A Single Center Experience
Chia-Mu Tsai1, I-Hsuan Chen1,2, Yin-Shen Chen1, Jen-Tai Lin1, Jeng-Yu Tsai1, Chia-Cheng Yu1,2,3, Tony Tong-Lin Wu1,3
1 Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
2 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
3 Department of Pharmacy, Tajen University
OBJECTIVE:
Although partial cystectomy is not the gold standard treatment for muscle-invasive bladder cancer, a solitary lesion in a suitable location is amenable to segmental resection with adequate margins. On the other hand, when advanced gynaecological or colorectal malignancy involves the urinary bladder, partial cystectomy has its role in bladder preservation for better quality of life. Thus we review our experience of treating pelvic malignancy with partial cystectomy at our institution.
PATIENTS AND METHODS:
From 1991 to 2010, a total of 45 patients underwent partial cystectomy as en bloc resection for urological and nonurological pelvic malignancies. Fifteen of them were pT1-3 bladder cancer, mostly urothelial carcinoma. The other 30 patients had urinary bladder invasion from colorectal or gynaecological cancers. We retrospectively reviewed these cases to evaluate the oncologic control perioperative morbidities, and quality of life after partial cystectomy.
RESULTS:
Five of 15 patients were lost to follow up, thus the median followup was 48.4 months (50% male, mean age: 66.2). 5-year recurrence free rate was 50% (5/10), median time to recurrence was ten months. Mortality rate was 20% (2/10). In mortality cases, one patient is diagnosed with bone metastases initially and another patient is later diagnosed with pT4N2Mx after he received radical cystectomy. 16 of 29 patients were diagnosed with bladder invasion after formal pathological report, only one case had urinary bladder recurrence in 7 months. One patient expired in 3 months due to pneumonia, 14 patients were recurrence free in urinary bladder at least 1 year, mean recurrence free time is 5.54 years.
CONCLUSIONS:
From our experience, partial cystectomy for bladder cancer control is still controversial. Further prospective or large scale study is needed. However, en bloc resection for non-urological pelvic malignancy in bladder invasion is feasible for tumor control.