Connolly Stephen S, Rochester Mark A
Department of Surgical Oncology, Addenbrooke's Hospital, Cambridge University, Cambridge, UK.
Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
BJU Int. 2015 Nov;116(5):780-90. doi: 10.1111/bju.12827. Epub 2015 Jul 22.
To report registry data obtained by the British Association of Urological Surgeons (BAUS) for nephroureterectomy (NU) surgery in the UK performed between 1 January and 31 December 2012.
SUBJECTS/PATIENTS AND METHODS: Registry data entered by each individual surgeon's team (self-reported) on all 6042 nephrectomy surgeries reported to BAUS during 2012 were analysed to identify all NU surgery. Parameters for analysis included demographics, indication, type of surgery, histopathology and complications (Clavien system) of surgery. Data did not include tumour location or multiplicity, preoperative diagnostic evaluation or details of minimally invasive surgery (MIS) undertaken. Before analysis for this report a central process of 'data-cleansing' was undertaken by a BAUS group to address any discrepancy between the listed surgery and the preoperative indication.
In all, 863 NU surgeries were included, performed by 220 consultant surgeons in 119 centres, and the median (range) number of NU per surgeon and unit was 3 (1-20) and 6 (1-29), respectively. The most common age group was 71-80 years (40%), most were male (64%), and haematuria was the most common presentation (74%). The dominant pathology was upper tract urothelial cancer (89%, 735), with final stage ≥pT2 in 47% (367), and the grade was 1, 2 or 3 in 6% (38), 36% (228) and 58% (362) respectively. Operative technique included MIS in 85% (720) and total reported operative complication rate (any Clavien) was 15% (128), of which Clavien ≥3 was reported in 4% (36), and perioperative death was reported in nine patients (1%). Advantages in favour of MIS included reduced hospital stay (median 5 vs 8 days), reduced major blood loss (3% vs 14%) and reduced transfusion requirement (6% vs 24%). In all, 76 cases (8%) were excluded from analysis based on benign pathology leading to reassignment to the 'simple nephrectomy' category.
NU is currently a low-volume operation (median 3 cases/year) within the remit of the nephrectomy surgeon, but is a safe procedure with a relatively low complication rate. Most NU surgery in the UK is now performed with laparoscopic assistance, with advantages including reduced major blood loss, reduced transfusion requirement and shorter hospital stay.
报告英国泌尿外科医师协会（BAUS）获取的2012年1月1日至12月31日期间在英国进行的肾输尿管切除术（NU）手术的登记数据。
受试者/患者及方法：分析每位外科医生团队（自我报告）输入的2012年向BAUS报告的所有6042例肾切除术手术的登记数据，以识别所有NU手术。分析参数包括人口统计学、手术指征、手术类型、组织病理学和手术并发症（Clavien系统）。数据不包括肿瘤位置或数量、术前诊断评估或所进行的微创手术（MIS）细节。在对本报告进行分析之前，BAUS小组进行了一个“数据清理”的核心过程，以解决所列手术与术前指征之间的任何差异。
总共纳入了863例NU手术，由119个中心的220名顾问外科医生进行，每位外科医生和每个单位的NU中位数（范围）分别为3例（1 - 20例）和6例（1 - 29例）。最常见的年龄组为71 - 80岁（40%），大多数为男性（64%），血尿是最常见的表现（74%）。主要病理类型为上尿路尿路上皮癌（89%，735例），47%（367例）为≥pT2期，分级为1级、2级或3级的分别占6%（38例）、36%（228例）和58%（362例）。手术技术包括85%（720例）采用MIS，报告的总体手术并发症发生率（任何Clavien分级）为15%（128例），其中Clavien≥3级的报告为4%（36例），围手术期死亡报告9例（1%）。MIS的优势包括住院时间缩短（中位数5天对8天）、大出血减少（3%对14%）和输血需求减少（6%对24%）。总共76例（8%）因良性病理被排除分析，重新归类为“单纯肾切除术”类别。
目前，NU在肾切除术外科医生的工作范围内是一项低例数手术（中位数每年3例），但却是一种并发症发生率相对较低的安全手术。英国目前大多数NU手术是在腹腔镜辅助下进行的，其优势包括大出血减少、输血需求减少和住院时间缩短。
