Clipping the extremity of ureter prior to nephroureterectomy is effective in preventing subsequent bladder recurrence after upper urinary tract urothelial carcinoma
- Author:
- No author available
- Journal Title:
- Chinese Medical Journal
- Issue:
- 21
- DOI:
- 10.3760/cma.j.issn.0366-6999.2012.21.014
- Key Word:
- bladder cancer;nephroureterectomy;recurrence;upper urinary tract urothelial carcinoma
Abstract： Background Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma (UTUC).This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy (NU)to prevent bladder recurrence after UTUC.Methods Patients with clinical diagnosis of UTUC were subjected to open trans-peritoneal NU and were randomly divided into two groups.One group received modified NU:clipping the distal ureter prior to NU; while the other group underwent traditional standard NU.Subsequent bladder recurrence was the primary endpoint.Results From January 2007 to December 2009,85 eligible cases were enrolled in this study.Modified NU and standard NU were performed on 42 and 43 patients,respectively.Operation time ((215.73±21.26) minutes vs.(220.19±15.35)minutes),blood loss ((105.15±11.32) ml vs.(110.12±9.07) ml),transfusion event (11.20％ vs.9.78％),and the in-patient time (10.0 days vs 9.5 days) were not significant between the two groups.After a median follow-up of 28 months (5-60),six (14.3％) cases who received modified NU had bladder recurrence,which was significantly lower compared with 15 (34.9％) patients from the group that underwent standard NU (P=0.026).In univariate and multivariate analysis,tumor grade (HR 4.33,95％CI 2.66-6.30,P=0.01) and operation type (HR 2.35,95％CI 1.53-3.48,P=0.041) were independent risk factors for subsequent bladder recurrence after UTUC.Conclusions Clipping the distal ureter at the beginning of NU significantly reduces bladder recurrence after UTUC.It is reasonable to conclude that clipping the distal portion of ureter trans-peritoneal is an effective surgical procedure for the treatment of UTUC.
- [1]CHEN Si-yang,DU Lin-dong,ZHANG Yu-hai.Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence[J].2010,(23).
- [2]Kauffman EC,Raman JD.Bladder cancer following upper tract urothelial carcinoma.[J].2008,8(1).
- [3]T R, Fleming,D P, Harrington,P C, O'Brien.Designs for group sequential tests.[J].1984,5(4).
- [4]D P, Zubac,B, Kihl.One or two incisions for nephroureterectomy in transitional cell renal pelvis tumours.[J].1997,31.
- [5]J, Krogh,E, Kvist,B, Rye.Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences.[J].1991,67(1).
- [6]D M, Murphy,H, Zincke,W L, Furlow.Management of high grade transitional cell cancer of the upper urinary tract.[J].1981,125.
- [7]N L, Geller,S J, Pocock.Interim analyses in randomized clinical trials: ramifications and guidelines for practitioners.[J].1987,43.
- [8]Angulo JC,Hontoria J,Sanchez-Chapado M.One-incision nephroureterectomy endoscopically assisted by transurethral ureteral stripping.[J].1998,52(2).
- [9]Hall MC,Erickstad MD,Roehrborn CG,etc.Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients.[J].1998,52(4).
- [10]Stephan Roth,Hermann van Ahlen,Axel Semjonow,etc.Modified Ureteral Stripping as an Alternative to Open Surgical Ureterectomy[J].1996,155(5).
- [11]Holmang S,Johansson SL.Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome.[J].2006,175(1).
- [12]Jay D, Raman,Douglas S, Scherr.Management of patients with upper urinary tract transitional cell carcinoma.[J].2007,4(8).
- [13]S J, Pocock,R, Simon.Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial.[J].1975,31.
- [14]C, Anderstr?m,S L, Johansson,S, Pettersson,etc.Carcinoma of the ureter: a clinicopathologic study of 49 cases.[J].1989,142(2 Pt 1).
- [15]Hutterer G,Zigeuner RE,Chromecki T,etc.Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location.[J].2006,98(6).
- [16]Vicente J,Palou J,Xavier B,etc.Transurethral resection of the intramural ureter as the first step of nephroureterectomy.[J].1995,154(1).
- [17]Jewett MA.Upper tract urothelial carcinoma.[J].2006,175(1).
- [18]Saighi D,Zerbib M,Giovansili B,etc.Stripping technique for endoscopic management of distal ureter during nephroureterectomy: experience of 32 procedures.[J].2004,64(3).
- [19]H P, McDONALD,W E, UPCHURCH,C E, STURDEVANT.Nephro-ureterectomy: a new technique.[J].1952,67.
- [20]W, Oosterlinck,E, Solsona,A P M, van der Meijden,etc.EAU guidelines on diagnosis and treatment of upper urinary tract transitional cell carcinoma.[J].2004,46(2).