內視鏡腎臟保留手術於治療上泌尿道泌尿上皮癌之腫瘤相關預後
沈志宇、蔡育賢、歐建慧、蔡宗欣、楊文宏
國立成功大學醫學院附設醫院 泌尿部
Oncologic outcomes of kidney sparing surgery using endoscopic management of upper urinary tract urothelial carcinoma: A single center experience
Chih-Yu Shen, Yuh-Shyan Tsai, Chien-Hui Ou, Tzong-Shin Tzai, Weng-Horng Yang
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose: While radical nephroureterectomy remains standard of care for upper tract urothelial carcinoma (UTUC), it is now proposed that by using kidney sparing surgery the patients could benefit from avoiding morbidity of nephrectomy. We’ve examined the oncologic outcomes of endoscopic management of UTUC.
Materials and methods: A total of 21 patients who received endoscopic management of UTUC at a single center in Taiwan were included from April 2004 to February 2017. Endoscopic tumor ablation was performed through percutaneous nephrostomy or via retrograde semirigid ureteroscopic aid. Tumors were biopsied first then treated with fulguration, the neodymium:YAG, or the holmium:YAG LASER. Patients were then followed on a stringent postoperative endoscopic and image protocol.
Results: Of the 21 patients (10 males and 11 females) included, the mean age was 69.6 ± 9.5 years. In terms of tumor clinical staging, there were 12 patients Ta, 8 T1 and 1 T3. As for histologic grading, there were 5 patients low grade and 16 high grade. Fifteen patients (71.4%) had multifocal urothelial carcinoma. The mean follow-up time was 36.2 months (2-155 months). During follow up, twelve patients had tumor relapse, of which, eight (38.0%) patients had bladder recurrence, one (4.7%) had distant metastasis, one (4.7%) had local recurrence, and three (14.2%) had ipsilateral recurrence with subsequent nephroureterectomy. The mean time to bladder recurrence was 16.37 months (6-31 months); the mean 5-year progression-free survival was 50.59%. The 5-year overall survival rate was 72.91%; two patients were lost to follow-up, and no patient expired. The mean preoperative creatinine level was 1.98 mg/dL, and at 12 months after operation it was 3.8 mg/dL .
Conclusion: In our experience, endoscopic management of UTUC could be an alternative approach. Despite a higher relapse rate, this approach may decelerate the deterioration of renal function compared with nephroureterectomy.