Carcinological Risks and Retroperitoneal Laparoscopy
Carcinological Risks and Retroperitoneal Laparoscopy
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癌症风险和腹膜后腹腔镜检查
DOI：
10.1159/000020339
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发表时间：
2000
期刊：
影响因子：
23.4
通讯作者：
C. Abbou
中科院分区：
文献类型：
--
作者：
A. Cicco;L. Salomon;H. Hoznek;W. Alamé;F. Saint;M. Bralet;P. Antiphon;D. Chopin;C. Abbou
目的：确定与后腹膜腹腔镜肿瘤切除术相关的套管针部位溢出、局部复发和转移性疾病的发生率。方法：从 1994 年到 1999 年，我们机构进行了 228 例后腹膜腹腔镜手术。 56 例手术 (24.6%) 涉及恶性肿瘤，包括 41 例根治性肾切除术和 8 例肾肿瘤部分肾切除术，以及 7 例肾盂肿瘤肾输尿管切除术。根据1997年TNM分类记录病理分期和手术切缘状态。术后随访数据通过1个月和3个月后的体格检查和放射学检查获得，然后每半年一次。记录套管针部位种植、局部复发和转移性疾病。 Kaplan-Meier 精算分析用于确定无病生存可能性。结果：平均随访时间为 24.9±13.85 个月。所有患者的手术切缘均无肿瘤。未发现腹腔镜套管针部位复发。腹腔镜根治性肾切除术：1例患者术后9个月局部复发并伴有pT3G2肿瘤肝转移，术后19.7个月死亡。一名 pT3aG3M+ 肿瘤患者在根治性肾切除术后 23.1 个月死亡，没有任何局部复发迹象。对于腹腔镜肾输尿管切除术：一名 pT3G3 肿瘤患者术后 12.1 个月局部复发，并于术后 26.6 个月死亡。一名患有 pT1G2 肾盂肿瘤的患者在 9 个月时发生骨转移，并在手术后 29 个月死亡。 Kaplan-Meier精算显示，根治性肾切除术的54个月无病生存率为91%，肾输尿管切除术的30个月无病生存率为61%，肾部分切除术的49个月无病生存率为100%。结论：上尿路恶性肿瘤可以通过后腹膜腹腔镜治疗。短期结果表明，该手术与端口部位或局部复发风险增加无关，并且无病生存率与开放手术相当。
Purpose: To determine the incidence of trocar site spillage, local recurrence, and metastatic disease associated with retroperitoneal laparoscopic tumor resection.Methods: From 1994 to 1999, 228 retroperitoneal laparoscopic procedures were performed at our institution. Fifty–six procedures (24.6%) were for malignancies and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumors, and 7 nephro–ureterectomies for renal pelvis tumors. The pathological stage and the status of surgical margins were noted according to the 1997 TNM classification. Postoperative follow–up data were obtained by means of physical and radiological examinations after 1 and 3 months, and then half–yearly. Trocar site seeding, local recurrence and metastatic disease were recorded. Kaplan–Meier actuarial analysis was used to determine the disease–free survival likelyhood.Results: The mean follow–up was 24.9±13.85 months. All the patients had tumor–free surgical margins. No laparoscopic trocar site recurrences were identified. For laparoscopic radical nephrectomy: one patient had a local recurrence with hepatic metastasis of a pT3G2 tumor after 9 months and died 19.7 months after the procedure. One patient with a pT3aG3M+ tumor died 23.1 months after radical nephrectomy without any sign of local recurrence. For laparoscopic nephro–ureterectomy: one patient with a pT3G3 tumor had a local recurrence 12.1 months after the procedure and died 26.6 months after surgery. One patient with a pT1G2 renal pelvis tumor had bone metastasis at 9 months and died 29 months after the procedure. The Kaplan–Meier actuarial disease–free survival rate was 91% at 54 months for radical nephrectomy, 61% at 30 months for nephro–ureterectomy and 100% at 49 months for partial nephrectomy.Conclusion: Malignancies of the upper urinary tract can be managed by means of retroperitoneal laparoscopy. Short–term results suggest that this procedure is not associated with an increased risk of portsite or local recurrence, and that disease–free survival is equivalent to that obtained with open surgery.