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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 646-652. doi: 10.19723/j.issn.1671-167X.2019.04.009

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Comparison of efficacy and safety between two different methods of nephroureterectomy in two centers

Jin-feng WU1,Rong-cheng LIN2,You-cheng LIN1,Wang-hai CAI1,Qing-guo ZHU1,Dong FANG2,Geng-yan XIONG2,Lei ZHANG2,Li-qun ZHOU2,Lie-fu YE1,△(),Xue-song LI2,△()   

  1. 1. Department of Urology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provicial Jinshan Hospital,Fuzhou, 350001, China
    2. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
  • Received:2019-03-20 Online:2019-08-18 Published:2019-09-03
  • Contact: Lie-fu YE,Xue-song LI E-mail:yeliefu@126.com;pineneedle@sina.com
  • Supported by:
    Supported by the Youth Project of the Health Commission of Fujian Province(2012-2-3)

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Abstract:

Objective: To compare the efficacy and safety of complete transperitoneal laparoscopic nephroureterectomy (CTNU) and traditional retroperitoneoscopic nehroureterectomy (TRNU) for the management of upper urinary tract urothelial carcinoma(UTUC).Methods: We retrospectively collected the clinical data of UTUC patients who underwent CTNU or TRNU surgery from January 2011 to December 2018 in Peking University First Hospital and Fujian Provincial Hospital, and compared the clinical characteristics, perioperative parameters, and follow-up results between the CTNU and TRNU surgeries.Results: Finally, a total of 266 cases were included, with 94 cases in the CTNU group and 172 cases in the TRNU group. The proportion of left side lesions was bigger in TRNU group when compared with CTNU group (P<0.05). No significant differences were observed in clinical characteristics, such as age, gender, body mass index(BMI), American society of anesthesiologists score(ASA score) and tumor laterality. All surgery procedures were completed. The vascular resparing was performed by reason that left arteria renalis was injured accidently during surgical operation in one case of TRNU group. No serious complications were observed in both CTNU and TRNU groups. In CTNU group, operating time was (202.9±76.7) min, estimated blood loss was (68.4±73.3) mL, drainage duration was (3.9±1.5) d, drainage volume was (181.7±251.5) mL, and postoperative hospital stay was (7.8±4.1) d. In TRNU group, operating time was (203.5±68.7) min, estimated blood loss was (130.2±252.1) mL, drainage duration was (4.3±1.6) d, drainage volume was (179.1±167.5) mL, and postoperative hospital stay was (8.2±3.7) d. The estimated blood loss in CTNU group was significantly less than that in TRNU group (P =0.005).The median follow-up time was 39 months (range: 1-88 months). The 5-year overall survival rate (OS), cancer specific survival rate (CSS), intra-vesical recurrence free survival rate (IvRFS), disease free survival rate (DFS) of CTNU group was 75.6%, 86.9%, 73.8%, 57.5%, respectively. The OS, CSS, IvRFS and DFS of TRNU group was 66.3%, 83.5%, 75.9%, 58.6%, respectively.No significant differences were observed in the OS, CSS, IvRFS and DFS between the CTNU and TRNU groups.Conclusion: CTNU technique is a safe and effective surgical option, and further prospective randomized controlled trial is needed for further evaluation.

Key words: Upper urinary tract, Urothelial carcinoma, Nephroureterectomy

CLC Number: 

  • R737.11

Figure 1

Four-point diamond layout"

Figure 2

Four-point rhombus layout"

Table 1

Clinical and pathological characteristics of all patients"

Items TRNU group(n=172) CTNU group(n=94) P value
Age/years, x?±s 67.1±11.5 66.0±9.2 0.437
Gender, n(%) 0.650
Male 92 (53.5) 53 (56.4)
Female 80 (46.5) 41 (43.6)
BMI(256 patients available)/(kg/m2), x?±s 24.4±2.9 23.9±3.4 0.342
Side, n(%) 0.001
Left 107 (62.2) 39 (41.5)
Right 65 (37.8) 55 (58.5)
Ureteroscopy, n(%) 0.517
Yes 29 (16.9) 13 (13.8)
No 143 (83.1) 81 (86.2)
ASA score (225 patients available), n(%) 0.085
1 6 (4.1) 9 (11.4)
2 112 (76.7) 59 (74.7)
3 28 (19.2) 11 (13.9)
Concomitant bladder cancer (206 patients available), n(%) 0.987
Yes 16 (11.2) 7 (11.1)
No 127 (88.8) 56 (88.9)
T stage, n(%) 0.523
Ta 4 (2.3) 2 (2.1)
T1 67 (39.0) 30 (31.9)
T2 50 (29.1) 30 (31.9)
T3 44 (25.6) 31 (33.0)
T4 5 (2.9) 1 (1.1)
Grade, n(%) 0.103
G1 51 (29.7) 37 (39.4)
G2 83 (48.3) 45 (47.9)
G3 38 (22.1) 12 (12.8)
Lymph node invasion, n(%) 0.403
N+ 7 (4.1) 6 (6.4)
N0 or Nx 165 (95.9) 88 (93.6)

Table 2

Intraoperative and postoperative situations of all patients"

Items TRNU group (n=172) CTNU group (n=94) P value
Operating time/min,x?±s 203.5±68.7 202.9±76.7 0.865
Estimated blood loss/mL,x?±s 130.2±252.1 68.4±73.3 0.005
Drainage duration/d,x?±s 4.3±1.6 3.9±1.5 0.090
Drainage volume/mL,x?±s 179.1±167.5 181.7±251.5 0.150
Postoperative hospital stay/d,x?±s 8.2±3.7 7.8±4.1 0.075
Perioperative complications,n/Clavien-Dindo grading 0.972
Intra-vesical hemorrhage 2/Ⅱ 1/Ⅱ
Reanal fossa hemorrhage 1/Ⅱ
Lymphatic fluid leakage 1/Ⅰ 1/Ⅰ
Ileus 1/Ⅱ

Figure 3

Follow-up results for TRNU and CTNU groups CTNU,complete transperitoneal laparoscopic nephroureterectomy; TRNU,traditional retroperitoneoscopic nephroureterectomy."

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