The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy
The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy
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DOI：
10.1046/j.1464-410x.2000.00888.x
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发表时间：
2000-10-01
影响因子：
4.5
通讯作者：
Tolley, DA
中科院分区：
文献类型：
--
作者：
McNeill, SA;Chrisofos, M;Tolley, DA
目的评价上尿路移行细胞癌(TCC)经腹腔镜肾输尿管切除术(LNU)和开腹肾输尿管切除术(ONU)的远期疗效。方法回顾分析67例肾输尿管切除术标本的临床资料和病理报告。记录每个患者的肿瘤分级、分期、淋巴状态和位置。结果本组病例中G2(44%)和G3(39%)患者比例较高，肿瘤分级与分期呈正相关(r=0.74P<；0.001)。在接受LNU治疗的25名患者中，22名患者发生了盆腔肾盏或输尿管上段移行细胞癌，其中3例(12%)需要中转开腹手术。本组TCC中，一半为G3，一半为侵袭性(PT1-3)。在ONU组，由于选择标准，输尿管肿瘤较多，总体16例(39%)为G3，一半为侵袭性。关于节点状况的信息载于一份LNU报告和两份ONU报告。术后平均随访LNU组32.9个月和ONU组42.3个月，其中ONU组死亡9例(21%)，LNU组死亡4例(16%)，术后平均生存时间分别为15.1个月和17个月(无统计学意义)。所有这些死亡都与G3PT1-3疾病有关。结论在本系列中，接受LNU和ONU的患者的病例组合和结果相似。由于腹腔镜肾手术术后并发症较少，在无局部侵袭或转移证据的情况下，在适当的情况下，向所有上尿路移行细胞癌患者提供LNU似乎是合理的。由于分级和分期之间有很强的相关性，初步输尿管镜检查和活检可能会影响所采用的手术方式。
Objectives To assess the long-term outcome of the endourological management of upper tract transitional cell carcinoma (TCC) by laparoscopic nephroureterectomy (LNU) or open nephroureterectomy (ONU).Patients and methods The records and pathology reports were reviewed retrospectively for 67 nephroureterectomy specimens (42 obtained by ONU and 25 by LNU). The grade, stage, lymph node status and site of the tumour were recorded for each patient. The primary end-point of the follow-up was disease-related death.Results Overall there was a high proportion of G2 (44%) and G3 (39%) disease, with a significant correlation between increasing grade and stage of TCC (r = 0.74, P < 0.001). Of the 25 patients who underwent LNU, 22 had pelvicalyceal or upper ureteric TCC and conversion to open surgery was required in three (12%). Of the TCCs in this group half were G3 and half were invasive (pT1-3). In the ONU group there were more ureteric tumours because of selection criteria and overall 16 (39%) were G3 and half were invasive. Information on nodal status was available in one LNU and two of the ONU reports. Within a mean follow-up of 32.9 months for LNU and 42.3 months for ONU, nine (21%) of the ONU group and four (16%) of the LNU group had died, with a mean survival of 15.1 and 17 months, respectively, after surgery (not significant). All of these deaths were associated with G3 pT1-3 disease.Conclusions In this series the case mix and outcomes were similar for those undergoing LNU and ONU. As laparoscopic renal surgery is associated with less postoperative morbidity it would seem reasonable to offer LNU to all patients with upper tract TCC, where appropriate and when there is no evidence of local invasion or metastasis. Because of the strong correlation between grade and stage, preliminary ureteroscopic assessment and biopsy may influence the surgical approach adopted.