Morselli Simone, Vitelli Ferdinando Daniele, Verrini Giorgio, Sebastianelli Arcangelo, Campi Riccardo, Liaci Andrea, Spatafora Pietro, Barzaghi Paolo, Ferrari Giovanni, Gacci Mauro, Serni Sergio, Brausi Maurizio
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
Front Surg. 2021 Dec 23;8:769527. doi: 10.3389/fsurg.2021.769527. eCollection 2021.
Laparoscopic surgery for Upper Urinary Tract Urothelial Cell Carcinoma (UTUC) is still debated for its possible seeding risk and thus consequent oncological recurrences, especially for atypical ones. The aim of the study is to compare recurrence and survival after Laparoscopic vs. Open Radical Nephroureterectomy (RNU) for Upper Urinary Tract Urothelial Cancer (UTUC). A retrospective evaluation of UTUC consecutive surgeries from 2008 to 2019 was conducted, including pT ≥ 2, High Grade UTUC who underwent RNU with bladder cuff excision without concomitant lymphadenectomy in three urological tertiary centers. Statistical analyses compared recurrence and cancer specific survival, based on surgical approach, while logistic multivariate analyses and Kaplan Meyer survival curve analyzed possible risk factors for recurrence and survival. One hundred seven cases of RNU, 47 (43.9%) laparoscopic and 60 (56.1%) open, were included in this report. Preoperative characteristics were comparable between groups. However, tumor stage was higher in the Open arm [T3-T4 in 44 (73.3%) vs. 20 (43.4%) in Laparoscopic]. Mean follow-up was 91.6 months in laparoscopy RNU vs. 93.5 months in open RNU. Recurrence rate (RR) was comparable between groups ( = 0.594), and so was the site, although 3 (6.3%) peritoneal recurrences were found only in laparoscopic group ( = 0.057). At multivariate logistic regression, tumor stage and surgical approach were independent predictors of recurrence ( < 0.05), while only tumor stage was predictor of cancer specific death ( = 0.029). Surgical approach has no impact on recurrence site, overall survival, and RR. Still, according to our data peritoneal carcinomatosis was present only in laparoscopic arm, despite how it didn't reach statistical significance.
腹腔镜手术治疗上尿路尿路上皮癌（UTUC）因其可能存在的种植风险以及由此导致的肿瘤复发，尤其是非典型肿瘤的复发，目前仍存在争议。本研究的目的是比较腹腔镜与开放根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）后的复发率和生存率。对2008年至2019年连续进行的UTUC手术进行回顾性评估，纳入了三个泌尿外科三级中心中pT≥2、高级别UTUC且接受了膀胱袖口切除术但未同时进行淋巴结清扫的患者。统计分析基于手术方式比较复发率和癌症特异性生存率，而逻辑多因素分析和Kaplan-Meier生存曲线分析了复发和生存的可能危险因素。本报告纳入了107例RNU病例，其中47例（43.9%）为腹腔镜手术，60例（56.1%）为开放手术。两组术前特征具有可比性。然而，开放手术组的肿瘤分期更高[T3-T4期在开放手术组为44例（73.3%），在腹腔镜手术组为20例（43.4%）]。腹腔镜RNU的平均随访时间为91.6个月，开放RNU为93.5个月。两组的复发率（RR）相当（P = 0.594），复发部位也相当，尽管仅在腹腔镜手术组发现了3例（6.3%）腹膜复发（P = 0.057）。在多因素逻辑回归分析中，肿瘤分期和手术方式是复发的独立预测因素（P < 0.05），而只有肿瘤分期是癌症特异性死亡的预测因素（P = 0.029）。手术方式对复发部位、总生存率和RR没有影响。尽管如此，根据我们的数据，腹膜种植转移仅出现在腹腔镜手术组，尽管未达到统计学意义。
