泌尿上皮腫瘤單孔後腹膜腔鏡腎臟輸尿管膀胱袖口切除手術之初期報告
林嘉彥 楊晨洸
臺中榮民總醫院外科部泌尿外科
Preliminary result of retroperitoneal laparoendoscopic single-site nephroureterectomy with bladder cuff excision (RLESS-NUC) in the management of upper urinary tract urothelial carcinoma
Chia-Yen Lin, Cheng-Kuang Yang
Divisions of Urology, Department of Surgery, Taichung Veteran General Hospital, Taichung, Taiwan
Purpose: To compare the peri-operative, pathological and preliminary oncological outcomes of retroperitoneal laparoendoscopic single-site nephroureterectomy with bladder cuff excision (RLESS-NUC) with those of conventional multiport laparoscopic nephroureterectomy with bladder cuff excision (LNUC) of upper urinary tract urothelialcarcinoma(UTUC)
Materials and Methods: We designed a new retroperitoneal method of LESS-NU via Gibson incision followed by conventional open method of bladder cuff excision. Between June 2011 and December 2014, total of 41 patients with clinically node-negative urothelial carcinoma of upper urinary tract underwent RLESS-NU. We performed a case control study of patients received LNU from 2009 to 2014. All the 143 procedures were performed by a single surgeon at a tertiary institution. Data were obtained from a prospectively maintained database.
Results: Patients’ demographics and tumor characteristics were similar after nest matching between the RLESS-NUC and LNUC groups.The mean operating time (without bladder cuff excision), estimated blood loss, blood transfusion rate, mean time of returning to liquid diet, and length of hospitalization for RLESS-NUC were 69.3 min, 75.6 mL, 2 from 42 patients, POD1, 4.6 days. And only 2 of RLESS-NUC group had post-operative ileus and all resolved within 3 days. Overall, the RLESS-NUC group revealed a non-inferior result comparing to LNUC group. There were no significant differences in perioperative outcome and complication rates. The proportion of patients with bladder recurrence, local recurrence and distant metastases was similar between the two groups. There were no significant differences in the recurrence-free survival, cancer-specific survival and overall survival rates between the two groups.
Conclusion: RLESS nephroureterectomy with bladder cuff excision from Gibson incision for upper urinary tract urothelial carcinoma is a safe, efficient, minimally invasive procedure and also adhere to oncologic principles. Both the oncological and peri-operative outcomes of patients who underwent RLESS-NUC compared well with those who underwent LNUC and with series of other surgical approaches.