達文西機器手臂輔助腎臟輸尿管切除手術於泌尿上皮癌治療之預後
賴谷順 歐宴泉
台中榮民總醫院外科部 泌尿外科
Oncology outcomes of robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper urinary tract urothelial carcinoma
Gu-Shun Lai, Yen-Chuan Ou
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Purpose
Nephroureterectomy with bladder cuff excision remains the golden standard for the treatment of upper urinary tract urothelial carcinoma. Laparoscopic nephroureterectomy have been widely reported and compared to open methods. Robotic nephroureterectomy is an alternative method for the management of upper urinary tract urothelial carcinoma. We evaluate the oncology outcome of robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper urinary tract urothelial carcinoma.
Materials and Methods:
During November 2010 to June 2016, patients undergoing robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for the treatment of upper urinary tract urothelial carcinoma were included. All the operations were performed by a surgeon through single docking method. Patients’ characteristics, peri-operative data, pathology results and oncology outcomes were analyzed.
Results
Forty-three patients were reviewed. Mean patient age was 71 years. The final pathologic results revealed Ta in 4.7%(n=2) of patients, carcinoma in situ in 4.7%(n=2), T1 in 30.2%(n=13), T2 in 11.6%(n=5), T3 in 39.5%(n=17), T4 in 9.3%(n=4). High grade tumors were present in 93%(n=40) and low grade in 7%(n=3). Median following duration was 31 months. At 2 and 5 years, overall survival was 86.7% and 72.3%, cancer specific survival was 89.9% and 74.9%, and recurrence free survival was 70.9% and 53.2%, respectively. Nineteen(44.2%) patients experienced disease recurrence, including 12(27.9%) with bladder recurrence, 4(9.3%) with local recurrence, and 7(16.2%) with distant metastasis.
Conclusion
To our knowledge, this study is the first report in Taiwan to evaluate the intermediate-term oncology outcomes for upper urinary tract urothelial carcinoma after robot-assisted laparoscopic nephroureterectomy with bladder cuff excision. The results seem satisfactory, but long-term follow-up with larger sample size were recommended.