Rouprêt Morgan, Hupertan Vincent, Sanderson Kristin M, Harmon Justin D, Cathelineau Xavier, Barret Eric, Vallancien Guy, Rozet François
Département d'Urologie, Institut Mutualiste Montsouris, Université Paris V, René Descartes, Paris, France.
Urology. 2007 Apr;69(4):656-61. doi: 10.1016/j.urology.2007.01.007.
To determine the surgical and oncologic outcomes in patients who underwent either open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU) for upper urinary tract transitional cell carcinoma.
We performed a retrospective review of data for patients who underwent ONU or LNU for upper urinary tract transitional cell carcinoma from 1994 to 2004 at one institution. The recorded data included sex, age, mode of diagnosis, smoking, history of bladder cancer, type of surgery, complications, tumor site, tumor size, tumor stage, tumor grade, length of hospital stay, recurrence, and progression. We also determined the recurrence and survival rates.
We reviewed the data for 46 patients. The median age was 70 years. Seven patients had a history of bladder cancer. Overall, 26 patients underwent ONU and 20 LNU. No differences in the complication rate (15% versus 15%) were observed. The median hospital stay was 4 days (range 3 to 6) after LNU and 9 (range 7 to 12) after ONU (P <0.001). The tumor stage and grade were independent prognostic factors for survival on multivariate analysis (P <0.05). The 5-year disease-specific survival rate was 89.4% for low-grade tumors and 63.1% for high-grade tumors (P = 0.04). ONU was associated with high-grade (P = 0.02) or invasive (P = 0.001) tumors. The 5-year tumor-free survival rate after ONU and LNU was 51.2% and 71.6%, respectively (P = 0.59).
LNU does not affect the mid-term oncologic control and enables a shorter hospital stay. It can be recommended as an alternative to ONU in the management of low-risk upper urinary tract transitional cell carcinoma (Stage T1-T2 and/or low-grade disease). However, long-term follow-up is necessary to recommend it for highly invasive tumors (Stage T3-T4 or N+).
确定接受开放性肾输尿管切除术（ONU）或腹腔镜肾输尿管切除术（LNU）治疗上尿路移行细胞癌患者的手术及肿瘤学结局。
我们对1994年至2004年在一家机构接受ONU或LNU治疗上尿路移行细胞癌患者的数据进行了回顾性分析。记录的数据包括性别、年龄、诊断方式、吸烟情况、膀胱癌病史、手术类型、并发症、肿瘤部位、肿瘤大小、肿瘤分期、肿瘤分级、住院时间、复发及进展情况。我们还确定了复发率和生存率。
我们回顾了46例患者的数据。中位年龄为70岁。7例患者有膀胱癌病史。总体而言，26例患者接受了ONU，20例接受了LNU。未观察到并发症发生率的差异（分别为15%和15%）。LNU术后中位住院时间为4天（范围3至6天），ONU术后为9天（范围7至12天）（P<0.001）。多因素分析显示肿瘤分期和分级是生存的独立预后因素（P<0.05）。低级别肿瘤的5年疾病特异性生存率为89.4%，高级别肿瘤为63.1%（P = 0.04）。ONU与高级别（P = 0.02）或浸润性（P = 0.001）肿瘤相关。ONU和LNU后的5年无瘤生存率分别为51.2%和71.6%（P = 0.59）。
LNU不影响中期肿瘤学控制，且能缩短住院时间。在低风险上尿路移行细胞癌（T1-T2期和/或低级别疾病）的管理中，可推荐其作为ONU的替代方法。然而，对于高度浸润性肿瘤（T3-T4期或N+），需要长期随访才能推荐使用。
