Tanaka Kazushi, Hara Isao, Takenaka Atsushi, Kawabata Gaku, Fujisawa Masato
Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Urology. 2008 Apr;71(4):728-34. doi: 10.1016/j.urology.2007.10.054. Epub 2008 Feb 15.
To determine the incidence of dissemination and port site metastases in patients undergoing laparoscopic surgery for urologic cancer.
From June 1992 to August 2005, 459 laparoscopic procedures were performed, 304 of which were for cancer. These included 162 radical prostatectomies, 67 radical nephrectomies, 20 partial nephrectomies, 45 nephroureterectomies, 5 retroperitoneal lymph node dissections of testicular cancers after chemotherapy, 3 radical cystectomies, and 2 other procedures. No patients without a histologic diagnosis of cancer were included in this study.
Of the 304 patients with cancer, 4 (1.3%) developed a local recurrence, including after retroperitoneal lymph node dissection in 2 patients, radical nephrectomy in 1, and radical cystectomy in 1. No port site metastases were observed. The histologic type of both testicular cancers was mixed germ cell tumor, with one occurring in a renal hilar lymph node and the other in a paraaortic lymph node and kidney. The histologic type of the renal cell carcinoma was papillary renal cell carcinoma with sarcomatoid features (Stage pT3aN1), and it occurred in a retrocaval lymph node. The histologic type of the bladder cancer was transitional cell carcinoma, Grade 3, Stage pT4aN0, and it presented as peritoneal carcinomatosis 11 months postoperatively.
The incidence of recurrence in our series was closely correlated with the range in previous reports. However, two recurrences were found in 5 patients who had undergone retroperitoneal lymph node dissection for testicular cancer after chemotherapy. Therefore, we should be careful when determining the indications for laparoscopic surgery in such patients.
确定接受腹腔镜手术治疗泌尿系统癌症患者的播散及端口部位转移的发生率。
1992年6月至2005年8月，共进行了459例腹腔镜手术，其中304例为癌症手术。这些手术包括162例根治性前列腺切除术、67例根治性肾切除术、20例部分肾切除术、45例肾输尿管切除术、5例化疗后睾丸癌的腹膜后淋巴结清扫术、3例根治性膀胱切除术以及2例其他手术。本研究未纳入无癌症组织学诊断的患者。
304例癌症患者中，4例（1.3%）出现局部复发，其中2例为化疗后睾丸癌行腹膜后淋巴结清扫术后复发，1例为根治性肾切除术后复发，1例为根治性膀胱切除术后复发。未观察到端口部位转移。两例睾丸癌的组织学类型均为混合性生殖细胞肿瘤，1例发生于肾门淋巴结，另1例发生于主动脉旁淋巴结及肾脏。肾细胞癌的组织学类型为具有肉瘤样特征的乳头状肾细胞癌（pT3aN1期），发生于腔静脉后淋巴结。膀胱癌的组织学类型为移行细胞癌，3级，pT4aN0期，术后11个月表现为腹膜种植转移。
我们系列研究中的复发率与既往报道范围密切相关。然而，在5例化疗后睾丸癌行腹膜后淋巴结清扫术的患者中发现了2例复发。因此，在确定此类患者的腹腔镜手术适应证时应谨慎。
