上泌尿道泌尿上皮癌內視鏡雷射燒灼術：單一醫學中心經驗
謝育哲、劉建良、蘇家震、沈坤宏、黃冠華
奇美醫學中心 外科部 泌尿科
Endoscopic Laser Ablation of Upper Tract Urothelial Carcinoma: Single Center’s Experience
Yu-Che Hsieh, Chien-Liang Liu, Chia-Cheng Su, Kun-Hung Shen, Steven K. Huang
Department of Surgery, Division of Urology, Chi Mei Medical Center, Tainan, Taiwan
Purpose:
Upper tract urothelial carcinomas (UTUC) are relatively uncommon tumors, however, there is a high incidence of UTUC in Taiwan. The gold standard treatment is radical nephroureterectomy (RNU) with excision of a cuff of bladder. However, kidney sparing management in select patients can be a reasonable alternative. Since there was no Taiwan formal report of kidney-sparing surgery for UTUC, we retrospective reviewed our single medical center experience.
Materials and Methods:
From Jun 2012 to Aug 2018, we retrospective review of all patients who had undergone endoscopic Thulium laser ablation using ureteroscopy of UTUC as their primary treatment. Hospital medical records were retrospectively studied to assess pathological verification, indication for kidney sparing treatment, and recurrence condition. Chi-square calculator was used to verify the p-value.
Results:
There was 40 patient undergone endoscopic Thulium laser ablation of UTUC in this 6 years. The mean age was 73 year-old with female predominant (65%). The mean follow up months was 20.9 (7 - 65) months. The indications of kidney sparing management were: solitary kidney, chronic kidney disease, small and low grade tumor, bilateral disease, and advanced medical comorbidity. For the tumor staging, 5 patients were Tis, 13 patients were Ta, and 22 patients were T1. We noticed that the low grade tumor's recurrence rate was significant lower that high grade (6 of 20, 30% vs 20 of 20, 100%; p < 0.001). For the biopsy stage, the recurrence rate were 15% (2 of 13), 60% (3 of 5), and 95% (21 of 22) for stage Ta, Tis, and T1 respectively (p = 0.002).
Conclusion:
UTUC is multifocal disease with high recurrence rate. Kidney sparing management of low risk UTUC (low grade, pTa) using endoscopic ablation may benefit to the selective patients. Tumor as Ta or low grade has change to recurrence free.