Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center
Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center
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DOI：
10.1089/end.2019.0308
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发表时间：
2019-09-25
影响因子：
2.7
通讯作者：
Patel, Anup
中科院分区：
文献类型：
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作者：
Defidio, Lorenzo;Antonucci, Michele;Patel, Anup
简介和目标：评价铥-钬：YAG（TL-HL：YAG）双激光在上尿路上皮癌（UTUC）保留肾逆行肾内手术（RC-RIRS）中的消融安全性和有效性。材料与方法：在三级中心（2005年1月至2018年12月）对178例转诊考虑RC-RIRS UTUC-eLA（内镜激光消融术）的连续患者进行了回顾性研究。使用标准化研究形式记录关键数据。结果如下：42例患者在接受内镜检查后拒绝接受严格的内镜监测方案，并前往其他地方接受替代治疗，留下136例患者，其中35例患者（25.7%）在接受原发性根治性肾输尿管切除术（RNU）（不适合保留肾脏）后退出。剩下101名候选人继续接受UTUC保守治疗（意向治疗[ITT]人群）。这101例患者的平均随访（FU）时间为28.7个月。末次随访（范围3-144个月）时，70例患者（69.3%）无复发，22例（21.8%）复发患者接受了内镜治疗，另有9例（8.9%）接受了RNU治疗。在ITT人群中，肾脏保留率为91%，而在紧急适应症中，肾脏保留率为87.5%。仅10%报告了Clavien-Dindo I级并发症（自限性血尿）。结论：在13年期间，使用TL-HL：YAG duo激光进行的RC-RIRS UTUC治疗是安全的，并且在肿瘤学上不劣于用于该适应症的替代组合激光能量技术。
Introduction and Objectives: To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and Methods: A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma. Results: After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%. Conclusions: Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication.