Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes
Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes
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DOI：
10.1089/end.2017.0915
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发表时间：
2018-02-21
影响因子：
2.7
通讯作者：
de Cobelli, Ottavio
中科院分区：
文献类型：
--
作者：
Musi, Gennaro;Mistretta, Francesco A.;de Cobelli, Ottavio
简介： 评估输尿管镜铥激光（TL）治疗上尿路癌（UTUC）的有效性和安全性。材料和方法：42 名连续患者在两个转诊机构接受了 UTUC 保守 TL 治疗。所有患者均接受初步活检，然后进行激光汽化。 272m 和 365m 激光纤维分别与柔性和半刚性瞄准镜一起使用。用10至20W的功率进行消融。结果：手术时平均年龄为 68 岁 (SD 10.7)。平均肿瘤大小为 14.3 毫米（范围 2-30 毫米）。初步活检显示 29 例 (69.1%) 患者存在低度病变，4 例 (9.5%) 患者存在高度病变，1 例原位癌 (2.4%) 存在，而 8 例 (19%) 患者尚无结论。最终分期为 pTa 和 pTis 的患者分别为 41 名 (97.6%) 和 1 名 (2.4%)。 38% (16) 经历过 Clavien-Dindo I 级并发症，47.6% (20) 经历过 II 级并发症，2.4% (1) 经历过 III 级并发症。五名 (12%) 患者因残留病灶而接受了二次检查。八名 (19%) 患者出现临床复发。中位估计无复发生存期为 44 个月 (SE 3.68)。四名患者（9.5%）接受了肾输尿管切除术。最终病理分期为pTis、pT3高级别、pTa低级别和pT0。中位随访时间为 26.3 个月（范围 2-54 个月），没有发生疾病进展或升期。结论： UTUC 的 TL 治疗是一种安全有效的保守治疗方法。我们的经验表明，在没有重大并发症的情况下，可以获得最佳的汽化和止血控制。
Introduction: To evaluate the efficacy and safety of ureteroscopic thulium laser (TL) treatment of upper urinary tract carcinoma (UTUC). Materials and Methods: Forty-two consecutive patients underwent conservative TL treatment for UTUC at two referral institutions. All patients underwent preliminary biopsy and then laser vaporization. A 272m and 365m laser fibers were used with a flexible and semirigid scope, respectively. Ablation was carried out with a 10 to 20W power. Results: Mean age at surgery was 68 years (SD 10.7). Mean tumor size was 14.3mm (range 2-30mm). Preliminary biopsy revealed the presence of low-grade disease in 29 (69.1%) patients, high-grade disease in 4 (9.5%) and 1 carcinoma in situ 1 (2.4%), whereas it was not conclusive in 8 (19%) cases. Final stage was pTa and pTis in 41 (97.6%) and 1 (2.4%) patients, respectively. Thirty eight percent (16) experienced Clavien-Dindo grade I complication, 47.6% (20) grade II, and 2.4% (1) grade III. Five (12%) patients underwent a second-look procedure due to residual disease. Eight (19%) patients experienced clinical recurrence. The median estimated recurrence-free survival was 44 months (SE 3.68). Four patients (9.5%) underwent a nephroureterectomy. Final pathological stage was pTis, pT3 high grade, pTa low grade, and pT0. Median follow-up was 26.3 months (range 2-54 months), and no progression or upstaging of disease occurred. Conclusions: TL management of UTUC is a safe and efficacious conservative treatment. Our experience shows optimal vaporization and hemostatic control in the absence of major complications.