新辅助化疗后上尿路上皮癌患者腹腔镜根治性肾输尿管切除术和区域淋巴结清扫术的围手术期结果。
Perioperative outcomes of laparoscopic radical nephroureterectomy and regional lymphadenectomy in patients with upper urinary tract urothelial carcinoma after neoadjuvant chemotherapy.
机构信息
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas.
出版信息
Urology. 2011 Jul;78(1):61-7. doi: 10.1016/j.urology.2011.01.002. Epub 2011 Feb 26.
OBJECTIVES
To determine the effect of neoadjuvant chemotherapy on the surgical outcomes in patients undergoing laparoscopic radical nephroureterectomy (LNUX) for upper urinary tract urothelial carcinoma (UTUC).
METHODS
We performed a retrospective review of all patients with UTUC who had undergone LNUX at our institution from January 2003 to June 2010. We compared the differences in demographic, clinicopathologic, and operative parameters, including the estimated blood loss, duration of surgery, length of postoperative hospitalization, and number of complications, between the patients who had undergone LNUX after neoadjuvant chemotherapy and those who had undergone LNUX without neoadjuvant chemotherapy. Logistic regression analysis was performed to identify the predictors of complications.
RESULTS
We identified 82 patients with UTUC who had undergone LNUX. Of these patients, 26 had received neoadjuvant chemotherapy. The patients who had undergone LNUX after neoadjuvant chemotherapy had a greater body mass index, greater biopsy tumor grade, and longer operative time than those who had undergone LNUX without neoadjuvant chemotherapy. The patients who received neoadjuvant chemotherapy had undergone regional lymphadenectomy more often, with more lymph nodes and lymphoadipose tissue removed, than those who had not received neoadjuvant chemotherapy. Neoadjuvant chemotherapy resulted in a 15% complete remission rate. No differences in the median estimated blood loss, intraoperative transfusion rate, or length of hospitalization between the 2 groups were found. The perioperative complication rates were similar in both groups.
CONCLUSIONS
We found no differences in the surgical outcomes between those patients who had undergone LNUX after neoadjuvant chemotherapy and those who had undergone LNUX without neoadjuvant chemotherapy. Our findings support the use of LNUX for selected patients undergoing neoadjuvant chemotherapy for UTUC.
目的
确定新辅助化疗对接受腹腔镜根治性肾输尿管切除术（LNUX）治疗上尿路上皮癌（UTUC）患者手术结果的影响。
方法
我们对 2003 年 1 月至 2010 年 6 月在我院接受 LNUX 治疗的所有 UTUC 患者进行了回顾性研究。我们比较了接受新辅助化疗后行 LNUX 治疗与未接受新辅助化疗行 LNUX 治疗的患者在人口统计学、临床病理和手术参数方面的差异，包括估计失血量、手术持续时间、术后住院时间和并发症数量。采用 logistic 回归分析确定并发症的预测因素。
结果
我们确定了 82 例接受 LNUX 治疗的 UTUC 患者。其中 26 例接受了新辅助化疗。与未接受新辅助化疗的患者相比，接受新辅助化疗后行 LNUX 治疗的患者体质量指数更大、活检肿瘤分级更高、手术时间更长。接受新辅助化疗的患者更常进行区域淋巴结清扫术，切除的淋巴结和脂肪组织更多。新辅助化疗使完全缓解率提高了 15%。两组患者的中位估计失血量、术中输血率或住院时间无差异。两组患者的围手术期并发症发生率相似。
结论
我们发现接受新辅助化疗后行 LNUX 治疗与未接受新辅助化疗行 LNUX 治疗的患者在手术结果方面无差异。我们的研究结果支持对接受新辅助化疗的特定 UTUC 患者使用 LNUX。
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