經腎臟輸尿管與膀胱袖口切除手術後剩餘輸尿管開口的泌尿道上皮癌復發
鄭嘉緯、楊文宏、歐建慧
Chia-Wei Cheng, Wen-Horng Yang, Chien-Hui Ou
Urothelial carcinoma recurrence over the residual ureteral orifice after nephroureterectomy and bladder cuff resection
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
國立成功大學醫學院附設醫院泌尿部
Objectives: To determine the impact of residual ureteral orifice after hand-assisted retroperitoneoscopic nephroureterectomy (HARN) for primary upper tract urothelial cancer. (UTUC)
Methods: We retrospectively reviewed patients with upper UTUC that had undergone HARN. Of these 105 patients, 67 of which belonged to the study group with ipsilateral residual ureteral orifice (RUO), while 38 patients served as controls with no residual ureteral orifice (NUO) postoperatively by follow up cystoscopy. We analyzed intravesical recurrence, local recurrence, and survival to assess the significance between two groups.
Results: Baseline demographics were comparable in both groups. In comparison with the RUO group, the NUO group was associated with a longer total operative time (150+/-78 vs.200+/-115 mins, p=0.03). Bladder recurrence was observed in 40 out of 67 (59.7%) in the RUO group and in 10 out of 38 (26%) in the NUO group (p=0.001) during median 39.7 months follow up. There was a significant difference in bladder cancer recurrence-free rate in the NUO group versus RUO group (p=0.04). Fifty-four percent (24/50) of first intravesical recurrence had a tendency of recurrence occurring near the area of ipsilateral ureteral orifice/scar especially in RUO group. (57.5% vs.40 %, p= 0.04). Most patients (94%) in whom a bladder tumor developed postoperatively were superficial and underwent transurethral resection of the bladder tumor. The cancer specific survival rate was not significantly different when we compared the RUO and NUO groups (p =0.42).
Conclusion: Residual ureteral orifice increased the risk of intravesical recurrence, but did not undermine survival after HARN for primary UTUC.