Zhou Xiaozhou, Ji Huixiang, Zhang Heng, Xiong Tailin, Pan Jinhong, Chen Zhiwen
1 Urology Institute of People's Liberation Army, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
2 Southwest Cancer Center, Third Military Medical University (Army Medical University), Chongqing, China.
J Int Med Res. 2018 Sep;46(9):3928-3937. doi: 10.1177/0300060518782015. Epub 2018 Jun 25.
Objectives To report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution. Methods We retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013. Results Of 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1-174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6-120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%). Conclusions En bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.
目的 报告我院原位尿流改道术后尿道复发的治疗情况。方法 我们回顾性分析了1998年1月至2013年1月期间接受根治性膀胱切除术和原位尿流改道的患者尿道复发的临床资料。结果 341例患者中，282例进行了随访（中位随访时间：56个月；范围：1 - 174个月）。8例患者在根治性膀胱切除术后发生尿路上皮癌局部复发。接受原位尿流改道的女性患者尿道复发率（1.4%）低于男性患者（3.3%）。根治性膀胱切除术和原位尿流改道术后复发的中位（范围）时间为33（6 - 120）个月。根据个体情况，复发采用经尿道肿瘤切除术、尿道切除术、新膀胱切除术、尿流改道修复术、辅助化疗或放疗进行治疗。生存分析显示，单纯尿道复发患者的5年癌症特异性生存率（83.3%）显著高于其他复发患者，包括盆腔/腹部复发和远处转移患者（26.8%）。结论 整块尿道切除术和尿流改道修复术仍是主要的手术选择。经尿道肿瘤切除术的选择基于肿瘤分期，用于精心挑选的患者。癌症特异性生存可能取决于多学科治疗。
