Yuan Changwei, Xu Chunru, Li Zhihua, Meng Chang, Du Yicong, Zhang Cuijian, Fang Dong, Li Xuesong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Transl Androl Urol. 2023 Jun 30;12(6):952-959. doi: 10.21037/tau-22-653. Epub 2023 May 31.
Open radical nephroureterectomy (RNU) with bladder cuff excision is the standard treatment for upper urinary tract urothelial carcinoma (UTUC). Traditional laparoscopic radical nephroureterectomy (LSRNU) is not minimally invasive enough due to the complex surgical procedure. This study aims to discuss the clinical feasibility and oncological outcomes of pure transperitoneal LSRNU for UTUC.
Between July 2010 and December 2020, 115 patients were admitted to the hospital with the diagnosis of UTUC treated with pure LSRNU by one surgeon. A special laparoscopic bulldog clamp was placed at the bladder cuff before cutting and suturing. The clinical and follow-up data were preoperatively collected and analyzed. Overall survival (OS) and cancer-specific survival (CSS) were estimated by the Kaplan-Meier method.
All surgeries were completed uneventfully in this cohort. The mean operative time was 145.69 minutes. The mean estimated blood loss was 56.61 mL. The mean removal time of the drain was 3.46 days. The mean time of having liquid diet was 1.32 days, and the ambulation time was 1.50 days. All surgeries were effectively completed, and no case required open conversion. According to the Clavien-Dindo classification system, postoperative complications occurred in two patients (II, III). The mean length of postoperative hospital stay was 5.78 days. The mean follow-up duration was 54.50 months. Recurrence in the bladder was 16.0% (15/94), compared with 4.6% (4/87) in the contralateral upper tract. The 5-year OS and CSS rates were 78.9% and 81.4%, respectively.
Pure transperitoneal LSRNU is a safe and effective minimally invasive technology for the treatment of UTUC.
开放性根治性肾输尿管切除术（RNU）并膀胱袖状切除术是上尿路尿路上皮癌（UTUC）的标准治疗方法。传统的腹腔镜根治性肾输尿管切除术（LSRNU）由于手术操作复杂，微创程度不够。本研究旨在探讨单纯经腹腔LSRNU治疗UTUC的临床可行性和肿瘤学结局。
2010年7月至2020年12月，115例诊断为UTUC的患者入院，由一名外科医生采用单纯LSRNU进行治疗。在切割和缝合前，在膀胱袖状部位放置一种特殊的腹腔镜牛头钳。术前收集并分析临床和随访数据。采用Kaplan-Meier法估计总生存期（OS）和癌症特异性生存期（CSS）。
该队列中的所有手术均顺利完成。平均手术时间为145.69分钟。平均估计失血量为56.61毫升。引流管平均拔除时间为3.46天。平均流食时间为1.32天，下床活动时间为1.50天。所有手术均有效完成，无一例需要转为开放手术。根据Clavien-Dindo分类系统，两名患者发生术后并发症（Ⅱ级、Ⅲ级）。术后平均住院时间为5.78天。平均随访时间为54.50个月。膀胱复发率为16.0%（15/94），对侧上尿路复发率为4.6%（4/87）。5年OS率和CSS率分别为78.9%和81.4%。
单纯经腹腔LSRNU是一种安全有效的微创技术，可用于治疗UTUC。
