Institute of Urology at St. Joseph's Healthcare, 3rd Floor Rm G344, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
World J Urol. 2013 Feb;31(1):175-81. doi: 10.1007/s00345-012-0915-0. Epub 2012 Jul 29.
To determine whether the method of bladder cuff excision (BCE) during laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma is associated with rates of disease recurrence or metastases.
We performed a retrospective review of all laparoscopic radical nephroureterectomies performed at our institution over 10 years. Three methods of BCE were used: transurethral incision (TUI) with Collins knife and a single intravesical port, open extravesical, and open intravesical via cystotomy. Logistic regression analyses were performed to determine whether BCE method was associated with recurrence or metastases.
Laparoscopic radical nephroureterectomy was performed in 110 patients. BCE was performed via TUI in 61 patients, open extravesical in 29, and open intravesical in 20. After a median follow-up of 22 months, 36 patients (32.7 %) developed recurrences. Metastases were observed in 18 patients (16.4 %). Recurrence rates were 32.8, 27.6, and 40.0 % in the TUI, extravesical, and intravesical groups, respectively (p = 0.69). Positive surgical margins occurred in nine patients with no significant difference between groups. Factors associated with recurrence or metastases in a multivariate regression analysis were stage, positive surgical margins and carcinoma in situ (CIS). The method of BCE was not associated with oncologic outcomes.
The three methods of bladder cuff excision (TUI, extravesical, and intravesical) are oncologically valid with similar recurrence and metastases rates when performed during laparoscopic radical nephroureterectomy. Stage, positive margin status and CIS are predictive of adverse oncologic outcomes and can facilitate postoperative prognostication.
确定在上尿路尿路上皮癌行腹腔镜根治性肾输尿管切除术时，膀胱袖套切除（BCE）的方法是否与疾病复发或转移的发生率有关。
我们对我院 10 年来所有行腹腔镜根治性肾输尿管切除术的患者进行了回顾性研究。BCE 采用经尿道切开（TUI）联合 Collins 刀和单个膀胱内端口、开放经膀胱外和开放经膀胱切开三种方法。采用逻辑回归分析确定 BCE 方法是否与复发或转移有关。
110 例行腹腔镜根治性肾输尿管切除术。61 例行 TUI，29 例行开放经膀胱外，20 例行开放经膀胱内。中位随访 22 个月后，36 例（32.7%）患者复发。18 例（16.4%）患者发生转移。TUI、经膀胱外和经膀胱内组的复发率分别为 32.8%、27.6%和 40.0%（p=0.69）。9 例患者切缘阳性，各组间无显著差异。多变量回归分析中与复发或转移相关的因素是分期、阳性切缘和原位癌（CIS）。BCE 方法与肿瘤学结果无关。
在腹腔镜根治性肾输尿管切除术中，膀胱袖套切除（TUI、经膀胱外和经膀胱内）三种方法在肿瘤学上是有效的，其复发和转移率相似。分期、阳性切缘状态和 CIS 是不良肿瘤学结果的预测因素，并有助于术后预后判断。
