Yoshida Takashi, Murota Takashi, Matsuzaki Tomoaki, Nakao Kazuyoshi, Ohe Chisato, Matsuda Tadashi, Kinoshita Hidefumi
Department of Urology and Andrology, Kansai Medical University Hospital, Hirakata, Japan.
Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka, Japan.
Eur Urol Open Sci. 2021 Apr 23;28:17-25. doi: 10.1016/j.euros.2021.03.009. eCollection 2021 Jun.
Although ureteroscopic surgery (URS) is beneficial for low-risk upper urinary tract carcinoma (UTUC), there is no standardized URS technique or navigation system for challenging cases.
To present a URS technique for UTUC using thulium (Tm):YAG and holmium (Ho):YAG lasers under photodynamic diagnosis (PDD) guidance, named PDD-guided dual laser ablation (PDD-DLA) and compare its efficacy with that of conventional Ho:YAG laser ablation (HLA; historical control).
The study included ten consecutive UTUC patients who underwent PDD-DLA between 2017 and 2019. The control group comprised 16 consecutive patients who underwent HLA between 2006 and 2016.
After oral administration of 5-aminolevulinic acid (20 mg/kg), UTUC tumors were endoscopically resected via PDD-DLA.
Clinical data were prospectively collected for our institutional UTUC data set. Disease progression, UTUC recurrence, and clinical outcomes were assessed.
PDD-DLA was successfully performed in all patients. The median tumor size was 23.5 mm (interquartile range [IQR] 12.8-30.0) and there were four cases (40.0%) of high-grade tumor. The median operative time was 120 min (IQR 98.5-142.5). No Clavien-Dindo grade ≥3 complications were observed. There were no differences in most clinical characteristics between the PDD-DLA and HLA groups. The 2-yr progression-free survival rate was 100% in the PDD-DLA group and 58.7% in the HLA group ( = 0.0197), and the 2-yr recurrence-free survival rate was 57.1% and 41.3%, respectively ( = 0.072). The PDD-DLA group had a lower incidence rate of salvage RNU compared with the HLA group (0.0% vs 50%; = 0.009). The small sample size might affect the reproducibility of these results.
PDD-DLA seems to be an effective and feasible endoscopic technique for UTUC treatment with favorable oncological outcomes.
We investigated a new laser technique for treating cancer of the upper urinary tract called photodynamic diagnosis-guided dual laser ablation. Our strategy was effective in removing tumors and stopping bleeding. Further studies in larger groups of patients are needed to confirm whether this technique improves cancer outcomes.
尽管输尿管镜手术（URS）对低风险上尿路癌（UTUC）有益，但对于具有挑战性的病例，尚无标准化的URS技术或导航系统。
介绍一种在光动力诊断（PDD）引导下使用铥（Tm）：钇铝石榴石和钬（Ho）：钇铝石榴石激光治疗UTUC的URS技术，称为PDD引导双激光消融（PDD-DLA），并将其疗效与传统的Ho：钇铝石榴石激光消融（HLA；历史对照）进行比较。
设计、设置和参与者：该研究纳入了2017年至2019年间连续接受PDD-DLA的10例UTUC患者。对照组包括2006年至2016年间连续接受HLA的16例患者。
口服5-氨基酮戊酸（20mg/kg）后，通过PDD-DLA对UTUC肿瘤进行内镜切除。
前瞻性收集我们机构UTUC数据集的临床数据。评估疾病进展、UTUC复发和临床结果。
所有患者均成功进行了PDD-DLA。肿瘤中位数大小为23.5mm（四分位间距[IQR]12.8-30.0），高级别肿瘤有4例（40.0%）。中位手术时间为120分钟（IQR 98.5-142.5）。未观察到Clavien-Dindo≥3级并发症。PDD-DLA组和HLA组在大多数临床特征上无差异。PDD-DLA组的2年无进展生存率为100%，HLA组为58.7%（P=0.0197），2年无复发生存率分别为57.1%和41.3%（P=0.072）。与HLA组相比，PDD-DLA组挽救性根治性肾输尿管切除术的发生率更低（0.0%对50%；P=0.009）。小样本量可能会影响这些结果的可重复性。
PDD-DLA似乎是一种有效且可行的内镜技术，用于UTUC治疗，具有良好的肿瘤学结果。
我们研究了一种治疗上尿路癌的新激光技术，称为光动力诊断引导双激光消融。我们的策略在切除肿瘤和止血方面有效。需要在更大规模的患者群体中进行进一步研究，以确认该技术是否能改善癌症治疗结果。
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