输尿管癌行后腹腔镜根治术后穿刺孔转移的单中心经验

Port site metastasis after retroperitoneal laparoscopic radical nephroureterectomy for ureter urothelial carcinoma:single-center experience

目的报告输尿管尿路上皮癌行后腹腔镜根治性肾输尿管切除术(RNU)术后穿刺孔转移的发生率及其临床特征。方法回顾性分析了西安交通大学第一附属医院2014年3月至2019年6月因单侧输尿管癌接受后腹腔镜联合下腹部切口切除患侧肾、输尿管全段及袖状膀胱的201例患者的围手术期及随访资料。根据输尿管内病灶或主要病灶的位置,将患者分为上段组及中下段组。结果186例患者被纳入研究。其中,44%的患者为上段组,56%的患者为中下段组。两组患者的肿瘤病理学分期和分级均无显著差异。术后中位随访时间15(9~60)个月,有3例(1.6%)女性患者在2~34个月被发现罹患穿刺孔转移(PSM),其原肿瘤均为T3N0M0及高级别尿路上皮癌。所有PSM患者均属上段组。结论后腹腔镜RNU术后PSM的发生可能与位于输尿管上段的进展期高级别尿路上皮癌相关。对于此类患者行开放手术或新辅助/辅助治疗,有改善其预后的潜在价值。

Objective To report the incidence and clinical characteristics of port site metastasis(PSM)in patients who received retroperitoneal laparoscopic radical nephroureterectomy(RNU)for ureter urothelial carcinoma.Methods The perioperative and follow-up data of 201 patients suffering from ureter urothelial carcinoma treated with retroperitoneal laparo⁃scopic RNU combined with open distal ureterectomy and excision of bladder cuff during Mar.2014 and Jun.2019 were retrospec⁃tively reviewed.The cohort was divided into two groups based on the location of primary lesions(upper segment group and mid-lower segment group).Results Altogether 186 patients were enrolled for analysis,including 44%in the upper segment group,and 56%in the mid-lower segment group.There were no differences in the distribution of pathological tumor staging and grad⁃ing between the two groups.After median follow-up of 15 months(range 9-60 months),PSM was reported in 3 female patients(1.6%)2 to 34 months postoperatively.The primary tumors were T3N0M0 and high-grade urothelial carcinoma.All PSM pa⁃tients were in the upper segment group.Conclusion High grade and advanced stage of upper segmental ureter urothelial carci⁃noma may associate with PSM after retroperitoneal laparoscopic RNU.Open surgery,neoadjuvant or adjuvant therapy have po⁃tential value to achieve good oncological prognosis.