Prolonged pneumoperitoneum time is an independent risk factor for intravesical recurrence after laparoscopic radical nephroureterectomy in upper tract urothelial carcinoma
Prolonged pneumoperitoneum time is an independent risk factor for intravesical recurrence after laparoscopic radical nephroureterectomy in upper tract urothelial carcinoma
复制标题
DOI：
10.1016/j.suronc.2017.01.003
复制
发表时间：
2017-03-01
影响因子：
2.3
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
--
作者：
Shigeta, Keisuke;Kikuchi, Eiji;Oya, Mototsugu
目的：为了评估气腹时间对接受腹腔镜根治性肾输尿管切除术（LRNU.Patients and Methods）的上尿路尿路上皮癌（UTUC）患者膀胱内复发（IVR）的影响：我们确定了2004年至2014年在我们的三个机构接受LRNU的129例UTUC患者。我们评估了IVR率与患者临床病理特征（包括手术时间）的相关性。通过回顾性分析所有的录像带，我们定义的气腹时间是从注入加压CO2气体与压力为10-12毫米汞柱的extirptation of the kidney.Results：在平均随访31.1个月，61（47.3%）随后IVR后LRNU。多变量分析显示，气腹时间延长（HR = 1.81，p = 0.025）和淋巴血管浸润（LVI）（HR = 1.53，p = 0.006）是后续IVR的独立风险因素。气腹时间>= 150 min的患者3年和5年无IVR生存率分别为43.7%和21.8%，显著低于其对应者（分别为59.0%和48.3%，p = 0.024）。气腹时间< 90 min的IVR发生率为27.3%，90-150 min为35.8%，150-210 min为55.0%，210-270 min为61.1%，270 min以上为85.7%。在接受LRNU的UTUC患者中，气腹时间的延长和LVI的存在可能与后续IVR的较高风险相关。(C)2017爱思唯尔有限公司版权所有
Objective: To evaluate the impact of pneumoperitoneum time on intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) patients who underwent laparoscopic radical nephroureterectomy (LRNU).Patients and methods: We identified 129 UTUC patients who underwent LRNU at our three institutions from 2004 to 2014. We evaluated the association of IVR rate and patient clinico-pathological characteristics including operation time. By retrospectively reviewing all videotapes, we defined pneumoperitoneum time as being from the infusion of pressurized CO2 gas with a pressure of 10-12 mmHg to extirpation of the kidney.Results: During the median follow-up of 31.1 months, 61 (47.3%) had subsequent IVR after LRNU. Multivariate analysis revealed that prolonged pneumoperitoneum time (HR = 1.81, p = 0.025) and presence of lymphovascular invasion (LVI) (HR = 1.53, p = 0.006) were independent risk factors for subsequent IVR. The 3-year and 5-year IVR free survival rates were 43.7% and 21.8% in patients with a prolonged pneumoperitoneum time of >= 150 min, which were significantly lower than those in their counterparts (59.0% and 48.3%, respectively, p = 0.024). The subsequent IVR rates were 27.3% for a pneumoperitoneum time of < 90 min, 35.8% for that of 90-150 min, 55.0% for that of 150-210 min, 61.1% for that of 210-270 min, and 85.7% for that of > 270 min.Conclusions: Prolongation of pneumoperitoneum time and presence of LVI might be associated with higher risk of subsequent IVR in UTUC patients who underwent LRNU. (C) 2017 Elsevier Ltd. All rights reserved.