以腎臟輸尿管切除術治療上泌尿道泌尿上皮細胞癌後的膀胱復發分析
王世鋒、洪巨軒、蔡樹衛、羅華安、王彥傑、陳國強、謝德生、林志明
國泰綜合醫院 外科部 泌尿科
Urinary bladder recurrence after nephroureterectomy for upper tract urothelial carcinoma
Shih-Feng Wang, Chu-Hsuan Hung, Shu-Wei Tsai, Wah-On Lo, Yen-Chieh Wang, Kuo-Chiang Chen, Teh-Sheng Hsieh, Chih-Ming Lin
Divisions of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
Purpose: We investigate the factors association with the urinary bladder recurrence after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC).
Materials and Methods: We retrospectively reviewed our experience of the patients who accepted NU for UTUC from Jan 1997 to Dec 2014. We analyzed risk factors of the urinary bladder recurrence after resection of kidney, ureter, and bladder cuff.
Results: During this 8-year period, 149 patients accepted NU for UTUC. 16 patients were excluded due to the combination with radical cystectomy, incomplete medical records, or loss of follow up. 33 (24.8%) patients had urinary bladder recurrence, and the mean duration from NU to recurrence was 11.39 months (2 – 38 months). We evaluated the recurrence-free survival (RFS) with Kaplan-Meier survival analysis. Laparoscopic NU had similar RFS with open NU (p=0.714). Regarding to the management method of bladder cuff, there was no difference about the RFS between pluck procedure and traditional extravesical bladder cuff resection (p=0.586). Histology grade of cancer cell had no influence on the RFS (p=0.551). The cancer stage 0a (pTa) had significant longer bladder RFS than other stages (p=0.024).
Conclusions: Laparoscopic NU and pluck procedure for bladder cuff resection are safe and effective technique for the management of UTUC. Cancer stage other than pTa have higher bladder recurrence rate and shorter RFS.