Honeck Patrick, Kienle Peter, Huck Nina, Neisius Andreas, Thüroff Joachim, Stein Raimund
Department of Urology, University Hospital Mannheim, Mannheim, Germany.
Department of General Surgery, University Hospital Mannheim, Mannheim, Germany.
Urology. 2017 May;103:209-213. doi: 10.1016/j.urology.2017.01.013. Epub 2017 Jan 18.
To report our experience of radical resection of secondary cancers after ureterosigmoidostomy. Ureterosigmoidostomy was the most common continent urinary diversion before the era of continent cutaneous diversion and neobladders, specifically in children. When performed for bladder exstrophy, patients will live with this kind of diversion for quite a long time. As a result, urologists will be confronted with patients presenting with an adenocarcinoma in their ureterosigmoidostomy. In most cases reported in the literature, an ileal conduit was used for urinary conversion. However, nowadays an ileal loop must not be the only solution for patients with a long life expectancy.
Between 2004 and 2015, 6 patients were treated for an adenocarcinoma in their ureterosigmoidostomy. All patients underwent radical resection of the tumor-bearing sigmoid colon. After thorough preoperative informed consent concerning the choice of future urinary diversion, such as conversion to an ileal conduit, construction of a continent catheterizable pouch, or repeat continent anal diversion, 4 patients chose a repeat continent anal urinary diversion.
Up to this date, no complications or recurrences were seen after a median follow-up of 35 months.
In patients with secondary malignancy of the colon, radical resection of the tumor-bearing bowel segment is mandatory. A repeat continent anal urinary diversion appears to be a feasible alternative to secondary urinary diversion after resection of the tumor-bearing sigmoid colon. However, a longer follow-up is required to determine whether the risk of secondary malignancy remains unchanged, and whether the risk is increased or decreased.
报告我们对输尿管乙状结肠吻合术后继发性癌症进行根治性切除的经验。在可控性皮肤造口术和新膀胱时代之前，输尿管乙状结肠吻合术是最常见的可控性尿流改道术，尤其在儿童中。当用于膀胱外翻时，患者将长期使用这种尿流改道术。因此，泌尿外科医生会遇到输尿管乙状结肠吻合术后出现腺癌的患者。在文献报道的大多数病例中，采用回肠导管进行尿液改道。然而，如今对于预期寿命较长的患者，回肠袢不应是唯一的解决方案。
2004年至2015年期间，6例输尿管乙状结肠吻合术后发生腺癌的患者接受了治疗。所有患者均接受了切除带肿瘤乙状结肠的根治性手术。在就未来尿流改道的选择，如改为回肠导管、构建可控性导尿袋或再次进行可控性肛门转流，获得充分的术前知情同意后，4例患者选择了再次进行可控性肛门尿流改道。
截至目前，中位随访35个月后未发现并发症或复发。
对于结肠继发性恶性肿瘤患者，必须切除带肿瘤的肠段。在切除带肿瘤的乙状结肠后，再次进行可控性肛门尿流改道似乎是继发性尿流改道的一种可行替代方案。然而，需要更长时间的随访来确定继发性恶性肿瘤的风险是否保持不变，以及风险是增加还是降低。
