達文西機器手臂輔助腎臟輸尿管切除手術於泌尿上皮癌之預後因子
賴谷順1、洪晟鈞1、裘坤元1、歐宴泉2
1台中榮民總醫院外科部泌尿科 ; 2童綜合醫院外科部泌尿科
Prognosis Factors of Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma
Gu-Shun Lai1、Sheng-Chun Hung1、 Kun-Yuan Chiu1、Yen-Chuan Ou2
1Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan ;
2Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital
Purpose
To report prognosis factors of robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for the management of upper urinary tract urothelial carcinoma in the intermediate-term follow-up.
Materials and Methods:
We reviewed 46 patients who had received robot-assisted laparoscopic nephroureterectomy with bladder cuff excision in our hospital for the treatment of their upper urinary tract urothelial carcinoma over an approximately 5 years period (November 2010 to November 2017). Operations were performed using the single-docking method. Oncology outcomes and prognosis factors are analyzed.
Results
The mean patient age was 71.4 years. On univariate analysis, male gender (p=0.04), stage T3/T4 tumor (p=0.025), history of and/or concurrent urinary bladder tumor (p=0.023) and impaired renal function (creatine > 2 mg/dl) (p=0.002) were significantly associated with the lower recurrence-free survival rate. Multifocal disease was associated with decreased cancer specific survival (p = 0.018). However, no factors were associated with poorer survival on multivariate analysis.
Conclusion
For upper urinary tract urothelial carcinoma, robot-assisted laparoscopic nephroureterectomy with bladder cuff excision was a relative new approach. Prognosis factors are similar to that of the laparoscopic and open approach. Long-term follow-up studies with larger sample size will be required to determine definitively the role of robot-assisted approach.