机器人辅助腹腔镜与传统腹腔镜根治性肾输尿管切除术治疗非转移性上尿路尿路上皮癌的安全性和有效性分析

Safety and efficacy analysis of robotic laparoscopy and conventional laparoscopy in the treatment of non-metastatic upper tract urothelial carcinoma

目的比较机器人辅助根治性肾输尿管切除术(RANU)和传统腹腔镜根治性肾输尿管切除术(LRNU)治疗非转移性上尿路尿路上皮癌(UTUC)的临床疗效。方法回顾性分析2018年7月至2021年12月吉林大学第一医院收治的73例非转移性UTUC患者的临床资料。根据手术方式将患者分为两组。RANU组27例,男15例,女12例;年龄(64.4±10.8)岁;体质量指数(BMI)(24.4±3.4)kg/m^(2);肾盂肿瘤16例,输尿管肿瘤9例,肾盂和输尿管肿瘤2例;肿瘤位于左侧16例,右侧11例。LRNU组46例,男17例,女29例;年龄(67.0±9.6)岁;BMI(23.8±3.0)kg/m^(2);肾盂肿瘤22例,输尿管肿瘤19例,肾盂和输尿管肿瘤5例;肿瘤位于左侧30例,右侧16例。两组一般资料比较差异均无统计学意义(P>0.05)。RANU组在机器人辅助腹腔镜下完成肾和上段输尿管切除,不更改患者体位,调整机械臂位置后完成下段输尿管和部分膀胱壁的切除。LRNU组腹腔镜下切除肾后,患者改仰卧位切除下段输尿管和部分膀胱壁。比较两组的手术时间、术中输血率、盆腔和肾窝引流管携带时间、术后住院时间、淋巴结清扫数量、术后并发症等的差异。结果两组手术均顺利完成,无中转开放手术。RANU组和LRNU组手术时间分别为185(176,208)min和132(115153)min(P<0.01);RANU组3例术中输血,LRNU组无输血病例(P=0.047)。RANU组和LRNU组淋巴结清扫数量分别为5.0(2.0,10.0)枚和0.5(0,4.0)枚,差异有统计学意义(P<0.05)。RANU组和LRNU组术后住院时间分别为5(4,6)d和5(5,6)d,盆腔引流管携带时间分别为5(3,5)d和4(3,4)d,肾窝引流管携带时间分别为4(3,5)d和4(3,5)d,淋巴结阳性例数分别为2例(7.4%)和5例(10.9%),术后短期(术后至出院日)并发症分别为5例(18.5%)和2例(4.4%),两组上述指标比较差异均无统计学意义(P>0.05)。RANU组中位随访时间14(11,19)个月,LRNU组中位随访时间31(25,40)个月。RANU组和LRNU组的膀胱无复发生存率分别为92.6%和91.3%,总生存率分别为96.3%和89.1%,无病生存率分别为88.9%和87.0%,差异均无统计学意义(P>0.05)。结论RANU是治疗非转移性UTUC安全、有效的手术方式,能达到与传统腹腔镜手术相似的控瘤效果,且RANU在淋巴结清扫数量上具有优势。

Objective To compare the clinical efficacy of robot-assisted radical nephroureterectomy(RANU)and conventional laparoscopic radical nephroureterectomy(LRNU)for the treatment of nonmetastatic upper urinary tract uroepithelial cancer(UTUC).Methods The clinical data of 73 patients with non-metastatic UTUC admitted to the First Hospital of Jilin University from July 2018 to December 2021 were retrospectively analyzed.In the RANU group,after completing the resection of the kidney and upper ureter under robotic-assisted laparoscopy,the resection of the lower ureter and part of the bladder wall was accomplished without changing the patients position,and the position of the robotic arm was adjusted.In the LRNU group,after laparoscopically resecting the kidney and the ureteral nephron,the resection of the lower ureter and part of the bladder wall was done in the supine position.There were 27 cases in the RANU group,including 15 males and 12 females;age(64.4±10.8)years old;body mass index(BMI)(24.4±3.4)kg/m^(2);16 renal pelvic tumors,9 ureteral tumors,and 2 tumors of the renal pelvis and ureters;the tumors were located in the left side of the 16 cases,and the right side of the 11 cases.In the LRNU group,there were 46 cases,including 17 males and 29 females;age(67.0±9.6)years old;BMI(23.8±3.0)kg/m^(2);22 renal pelvic tumors,19 ureteral tumors,and 5 tumors of the renal pelvis and ureter;the tumors were located on the left side in 30 cases,and on the right side in 16 cases.There was no statistically significant difference between the general characteristics of the two groups(P>0.05).The differences in operation time,intraoperative blood transfusion rate,pelvic and renal fossa drainage time,postoperative hospital stay,number of dissected lymph node,and postoperative complications were compared between the two groups.Results Surgery was successfully completed in both groups without transfering to open surgery.The operative time was 185(176,208)min and 132(115,153)min in the RANU group and the LRNU group,respectively(P<0.01);there were three cases of intraoperative blood transfusion in the RANU group,and no transfusion in the LRNU group(P=0.047).The number of dissected lymph node was 5.0(2.0,10.0)in the RANU group and 0.5(O,4.0)in the LRNU group,and the difference was statistically significant(P<0.05).The postoperative hospital stay in the RANU group and the LRNU group was 5(4,6)d and 5(5,6)d,the pelvic drainage time was 5(3,5)d and 4(3,4)d,the renal fossa drainage time was 4(3,5)d and 4(3,5)d,lymph node positivity rate was 2(7.4%)and 5(10.9%),and short-term postoperative(hospital stay)complications were 5(18.5%)and 2(4.4%),respectively,and there was no statistically significant difference in above-mentioned parameters between the two groups(P>0.05).The median follow-up time was 14(11,19)months in the RANU group and 31(25,40)months in the LRNU group.The bladder recurrence-free survival rate was 92.6%and 91.3%in the RANU group and the LRNU group,the overall survival rate was 96.3%and 89.1%,and the disease-free survival rate was 88.9%and 87.0%,respectively,and the difference was statistically insignificant(P>0.05).Conclusions RANU is a safe and effective surgical procedure for the treatment of non-metastatic UTUC,which can achieve similar tumor control as traditional laparoscopic surgery,and RANU has advantages in the number of lymph node dissection.