Photodynamic Diagnosis-guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes.
Photodynamic Diagnosis-guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes.
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DOI：
10.1016/j.euros.2021.03.009
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发表时间：
2021-06
影响因子：
2.5
通讯作者：
Kinoshita H
中科院分区：
文献类型：
--
作者：
Yoshida T;Murota T;Matsuzaki T;Nakao K;Ohe C;Matsuda T;Kinoshita H
虽然输尿管镜手术(URS)对低危上尿路癌(UTUC)是有益的，但目前还没有标准化的URS技术或导航系统来应对具有挑战性的病例。目的：介绍一种在光动力诊断(PDD)引导下使用Tm(Tm)：YAG和Ho(Ho)：YAG激光治疗UTUC的方法，即PDD引导双激光消融术(PDD-DLA)，并与传统Ho：YAG激光消融术(历史对照)进行比较。这项研究包括2017至2019年间连续接受PDD-DLA治疗的10名UTUC患者。对照组包括2006至2016年间连续接受人类白细胞抗原治疗的16名患者。口服5-氨基乙酰丙酸(20 mg/kg)后，经内窥镜下切除肿瘤。临床数据是为我们的机构UTUC数据集前瞻性收集的。评估疾病进展、UTUC复发和临床结果。所有患者均顺利完成PDD-DLA治疗。肿瘤大小中位数为2 3.5 mm(四分位数范围12.8~30.0)，高级别肿瘤4例(40.0%)。中位手术时间120min( 98.5~142.5)。无≥-DINDO分级并发症。PDD-DLA组和HLA组的大部分临床特征无差异。2年无进展生存率分别为100%和58.7%(p = 0.0197)，2年无复发生存率分别为57.1%和41.3%(p = 0.072)。PDDDLA组抢救获得性尿路感染发生率低于HLA组(0.0%vs50%；p = 0.009)。样本量较小可能会影响这些结果的重复性。PDD-DLA似乎是治疗UTUC的一种有效和可行的内窥镜技术，具有良好的肿瘤学结果。我们研究了一种新的治疗上尿路癌的激光技术，称为光动力诊断引导的双激光消融术。我们的策略在切除肿瘤和止血方面很有效。还需要在更大的患者群体中进行进一步的研究，以证实这项技术是否改善了癌症结果。
Although ureteroscopic surgery (URS) is beneficial for low-risk upper urinary tract carcinoma (UTUC), there is no standardized URS technique or navigation system for challenging cases. To present a URS technique for UTUC using thulium (Tm):YAG and holmium (Ho):YAG lasers under photodynamic diagnosis (PDD) guidance, named PDD-guided dual laser ablation (PDD-DLA) and compare its efficacy with that of conventional Ho:YAG laser ablation (HLA; historical control). The study included ten consecutive UTUC patients who underwent PDD-DLA between 2017 and 2019. The control group comprised 16 consecutive patients who underwent HLA between 2006 and 2016. After oral administration of 5-aminolevulinic acid (20 mg/kg), UTUC tumors were endoscopically resected via PDD-DLA. Clinical data were prospectively collected for our institutional UTUC data set. Disease progression, UTUC recurrence, and clinical outcomes were assessed. PDD-DLA was successfully performed in all patients. The median tumor size was 23.5 mm (interquartile range [IQR] 12.8–30.0) and there were four cases (40.0%) of high-grade tumor. The median operative time was 120 min (IQR 98.5–142.5). No Clavien-Dindo grade ≥3 complications were observed. There were no differences in most clinical characteristics between the PDD-DLA and HLA groups. The 2-yr progression-free survival rate was 100% in the PDD-DLA group and 58.7% in the HLA group (p = 0.0197), and the 2-yr recurrence-free survival rate was 57.1% and 41.3%, respectively (p = 0.072). The PDD-DLA group had a lower incidence rate of salvage RNU compared with the HLA group (0.0% vs 50%; p = 0.009). The small sample size might affect the reproducibility of these results. PDD-DLA seems to be an effective and feasible endoscopic technique for UTUC treatment with favorable oncological outcomes. We investigated a new laser technique for treating cancer of the upper urinary tract called photodynamic diagnosis–guided dual laser ablation. Our strategy was effective in removing tumors and stopping bleeding. Further studies in larger groups of patients are needed to confirm whether this technique improves cancer outcomes.
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影响因子：
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作者：
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