Sarmah Piyush Bhargav, Ehsanullah Syed Ali, Sarmah Bhupendra Dev
Department of Urology, Birmingham Heartlands Hospital, University Hospitals of Birmingham, Birmingham, UK.
Indian J Urol. 2020 Oct-Dec;36(4):276-281. doi: 10.4103/iju.IJU_93_20. Epub 2020 Oct 1.
Upper tract urothelial carcinoma (UTUC) is uncommon, accounting for 5%-10% of all urothelial carcinomas. Current standard of care for localized disease consists of radical nephroureterectomy (RNU) which leads to loss of half the patient's functioning nephrons. Percutaneous nephron-sparing surgery (PCNSS) is an alternative minimally-invasive approach in selected cases where nephron preservation is desired. The long-term outcomes of this procedure at a single center are described.
All patients undergoing PCNSS, with the operation carried out by a single surgeon, were included. Equipment used was a standard 26Ch resectoscope through a 30Ch Amplatz sheath, with all patients receiving postoperative intrapelvic Mitomycin. Data for each patient were collected on patient age; tumor size at diagnosis; grade; stage; oncological recurrence; requirement for subsequent RNU; and overall survival. Primary outcomes were disease recurrence and overall mortality, and secondary outcome was rate of subsequent RNU.
Fifteen patients in total underwent PCNSS, 14 were diagnosed with UTUC; benign leiomyoma was proven in one patient and excluded from final analysis. Overall survival at 5 and 10 years was 92.9% and 78.6%, respectively, with disease-specific mortality at 10 years of 7.1% (one patient who developed metastatic carcinoma); 21.4% of patients had recurrent ipsilateral UTUC and all required subsequent RNU for this indication. No patients had seeding of the percutaneous tract.
PCNSS for UTUC is a feasible approach to consider in carefully selected patients who agree to intensive follow-up, even for higher grade tumors. Where recurrent UTUC occurs, further management options still exist for disease treatment.
上尿路尿路上皮癌（UTUC）并不常见，占所有尿路上皮癌的5%-10%。目前针对局限性疾病的标准治疗方法是根治性肾输尿管切除术（RNU），这会导致患者一半的功能性肾单位丧失。经皮保留肾单位手术（PCNSS）是在希望保留肾单位的特定病例中采用的一种替代性微创方法。本文描述了该手术在单一中心的长期疗效。
纳入所有接受PCNSS且由同一外科医生实施手术的患者。使用的设备是通过30Ch安普瑞兹鞘的标准26Ch电切镜，所有患者术后均接受盆腔内丝裂霉素治疗。收集每位患者的以下数据：患者年龄；诊断时肿瘤大小；分级；分期；肿瘤复发情况；后续是否需要进行RNU；以及总生存期。主要结局为疾病复发和总死亡率，次要结局为后续RNU的发生率。
共有15例患者接受了PCNSS，其中14例被诊断为UTUC；1例患者经证实为良性平滑肌瘤，被排除在最终分析之外。5年和10年的总生存率分别为92.9%和78.6%，10年的疾病特异性死亡率为7.1%（1例发生转移性癌的患者）；21.4%的患者同侧UTUC复发，所有这些患者均因该指征需要后续进行RNU。没有患者出现经皮通道种植转移。
对于同意接受密切随访的精心挑选的患者，即使是高级别肿瘤，PCNSS也是一种可行的UTUC治疗方法。当UTUC复发时，仍存在进一步的疾病治疗管理选择。
