系統性回顧：迴腸膀胱擴張手術後惡性腫瘤案例探討
羅啟文、張尚仁、謝政興、楊緒棣
台北慈濟泌尿科 外科部 泌尿科
Systemic review of malignancy after ileocystoplasty
Chi-Wen, Lo, Shang Jen, Chang, Chang-Hsin Hsieh, Shei-Dei Yang
Divisions of Urology, Department of Surgery, Taipei Tzu Chi Hospital, New Taipei, Taiwan
Puropose
The incidence of post-ileocystoplasty malignancy is low and most published reports were case reports and only few sigle-cencer retrospective cohort study presented. Therefore, we systemically reviewed the published reports to pool the results for analysis to more clearly illustrate the characteristics and prognosis of malignancy associated with ileocystoplasty.
Methods
We did a systemic search of the PubMED® and CiNii for all cases with the following keywords: cystoplasty, enterocystoplasy, ileocystoplasty, ileum, urinary diversion, and malignancy or bladder cancer. The additional records on this topic were identified from references cited in the selected articles and previous review articles on this topic. Two of the authors (CWL and SJC) independently did the literature search and data extraction. The parameters retrieved from the reports included baseline patient characteristics, latency period, indications for surgery, presenting symptoms and signs, histological type, locus of tumor, follow-up period and survival which were analyzed with commercial software (Medcalc®, version 9.3, USA).
Results
There were 41 articles selected and analyzed prudently with 56 cases included in the review. The reported incidence ranged from 0.9% to 5.5% in patients underwent ileocystoplasty. The average age was 53.0 +/- 11.8 years old. Most malignancy occurred 15 years after ileocystoplasty (47/56, 83.9%) and the most commonly presenting symptoms were gross hematuria (60.0%). The locations of malignancy were mainly located at the ileobladder junction. Adenocarcinoma is most commonly observed histology among all cases (39/56) while urothelial carcinoma predominated in cases with neurogenic bladder (5/10). 17 of 45 patients (37.8%) presented with advanced disease and poor prognosis (median survival time was 6.0 months).
Conclusion:
The systemic review revealed low incidence of post-ileocystoplasty malignancy with majorly poor prognosis. Yearly cystoscopy surveillance may not be indicated in case within 15 years post-operatively except symptomatic patients.