Musi Gennaro, Mistretta Francesco A, Marenghi Carlo, Russo Andrea, Catellani Michele, Nazzani Sebastiano, Conti Andrea, Luzzago Stefano, Ferro Matteo, Matei Deliu V, Carmignani Luca, de Cobelli Ottavio
1 Department of Urology, Istituto Europeo di Oncologia, University of Milan , Milan, Italy .
2 Department of Urology, IRCCS Policlinico San Donato , San Donato Milanese, Italy .
J Endourol. 2018 Mar;32(3):257-263. doi: 10.1089/end.2017.0915. Epub 2018 Feb 21.
To evaluate the efficacy and safety of ureteroscopic thulium laser (TL) treatment of upper urinary tract carcinoma (UTUC).
Forty-two consecutive patients underwent conservative TL treatment for UTUC at two referral institutions. All patients underwent preliminary biopsy and then laser vaporization. A 272 μm and 365 μm laser fibers were used with a flexible and semirigid scope, respectively. Ablation was carried out with a 10 to 20 W power.
Mean age at surgery was 68 years (SD 10.7). Mean tumor size was 14.3 mm (range 2-30 mm). Preliminary biopsy revealed the presence of low-grade disease in 29 (69.1%) patients, high-grade disease in 4 (9.5%) and 1 carcinoma in situ 1 (2.4%), whereas it was not conclusive in 8 (19%) cases. Final stage was pTa and pTis in 41 (97.6%) and 1 (2.4%) patients, respectively. Thirty eight percent (16) experienced Clavien-Dindo grade I complication, 47.6% (20) grade II, and 2.4% (1) grade III. Five (12%) patients underwent a second-look procedure due to residual disease. Eight (19%) patients experienced clinical recurrence. The median estimated recurrence-free survival was 44 months (SE 3.68). Four patients (9.5%) underwent a nephroureterectomy. Final pathological stage was pTis, pT3 high grade, pTa low grade, and pT0. Median follow-up was 26.3 months (range 2-54 months), and no progression or upstaging of disease occurred.
TL management of UTUC is a safe and efficacious conservative treatment. Our experience shows optimal vaporization and hemostatic control in the absence of major complications.
评估输尿管镜铥激光（TL）治疗上尿路癌（UTUC）的疗效和安全性。
在两家转诊机构，42例连续患者接受了UTUC的保守TL治疗。所有患者均接受了初步活检，然后进行激光汽化。分别使用272μm和365μm的激光光纤，通过软性和半硬性输尿管镜进行操作。以10至20W的功率进行消融。
手术时的平均年龄为68岁（标准差10.7）。平均肿瘤大小为14.3mm（范围2 - 30mm）。初步活检显示，29例（69.1%）患者为低级别疾病，4例（9.5%）为高级别疾病，1例（2.4%）为原位癌，8例（19%）病例活检结果不明确。最终分期方面，41例（97.6%）患者为pTa期，1例（2.4%）患者为pTis期。38%（16例）出现Clavien-Dindo I级并发症，47.6%（20例）为II级，2.4%（1例）为III级。5例（12%）患者因残留病灶接受了二次手术。8例（19%）患者出现临床复发。估计无复发生存期的中位数为44个月（标准误3.68）。4例（9.5%）患者接受了肾输尿管切除术。最终病理分期为pTis、pT3高级别、pTa低级别和pT0。中位随访时间为26.3个月（范围2 - 54个月），未出现疾病进展或分期上升的情况。
TL治疗UTUC是一种安全有效的保守治疗方法。我们的经验表明，在无重大并发症的情况下，可实现最佳的汽化和止血控制。
