单中心1041例膀胱癌根治尿流改道患者手术疗效和并发症

【目的】探讨影响膀胱癌根治(RC)尿流改道术围手术期安全的因素。【方法】回顾性收集2001年1月至2020年8月在本中心泌尿外科接受RC术患者的临床病理指标、术后并发症及预后情况等指标并进行统计分析。并对其中2011-2020年的患者按开放手术组(ORC)、腹腔镜组(LRC)、机器人辅助腹腔镜组(RARC)进一步分析比较。本研究采用独立样本t检验、卡方检验、线性回归、K-M生存曲线等统计方法描述患者并发症及预后情况,Lo⁃gistic回归分析RC术后并发症的影响因素。【结果】在2001-2020年的1041例行RC术的患者中,中位年龄63(55~69)岁;男性和女性占比分别为86.0%和14.0%。比较2001-2010与2011-2020年前后10年数据,并发症发生率有明显下降(37.4%vs.26.7%)。分析2011至2020年667例RC术患者的并发症情况,中位随访时间34个月。其中ORC组415例,LRC组161例,RARC组91例。在尿流改道方式中,回肠导管术共计659例,占比63.3%;原位新膀胱术343例,占比32.9%。所有级别并发症发生率30.5%,最常见的并发症是泌尿系并发症(15.8%)。开放手术组总并发症和≥3级并发症发生率高于腹腔镜、机器人手术组(总并发症:ORC,30.8%;LRC,21.1%,RARC,24.2%;P=0.047;≥3级并发症:ORC,14.7%;LRC,9.3%,RARC,6.6%;P=0.043)。线性趋势检验分析提示,本中心患者近期(≤90 d)并发症发生率在2011年至2020年呈下降趋势(χ^(2)=10.013,P=0.002)。【结论】随着手术技术的提高和经验的积累,RC术后近期并发症发生率有下降趋势;与开放手术相比,微创手术特别是机器人辅助腹腔镜手术在降低并发症发生率上有一定优势。

Reassessment of the predictive role of perivesical fat invasion in invasive bladder cancer prognosis in 151 Chinese patients

Background Perivesical fat invasion is considered as an important prognostic factor for bladder cancer. However, the predictive role of perivesical fat invasion in invasive bladder cancer prognosis has never been reported in Chinese patients. The aim of the study was to assess the predictive value of perivesical fat invasion for prognoses of T2 and T3 bladder cancer in Chinese patients. Methods One hundred and fifty-one patients who underwent radical cystectomy for pT2-3NOM0 invasive bladder cancer from 2001 to 2007 were studied. Cancer-specific survival rate （CSS） and recurrence-free survival rate （RFS） were compared between the pT2 and pT3 patient groups. Other clinicopathological parameters were also retrospectively analyzed by univariate and multivariate analyses to identify the independent predictor for the prognoses of this cohort. Results Average patient age at surgery was 58 years. Ninety （60.3%） patients had grade I and II disease. During follow-up （median 66 months）, 27 patients （17.9%） had tumor recurrence and 18 （11.9%） died of bladder cancer. In the univariate analysis, the CSS and RFS curves between T2 and T3 patients showed no significant difference （P=-0.756 and 0.354, respectively）. Multivariate Cox regression showed that histological classification and grade were independent predictors for CSS, while grade was the sole independent predictor for RFS. Conclusions For this group of Chinese patients, perivesical fat invasion did not demonstrate a statistically significant difference in prognosis between T2 and T3 patients. Nontransitional cell carcinoma （non-TCC） and high-grade patients had short CSS, and patients with high-qrade tumor had higher recurrent risk.

Clipping the extremity of ureter prior to nephroureterectomy is effective in preventing subsequent bladder recurrence after upper urinary tract urothelial carcinoma

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.

Intra-arterial chemotherapy for pelvic recurrence after radical cystectomy for bladder urothelial cancer

Pelvic recurrence of urothelial carcinoma after radical cystectomy is considered infrequent but the prognosis is poor. The incidence of pelvic recurrence after radical cystectomy was 4%-19%, depending on the clinical stage of the bladder malignancy]＇2 Pelvic recurrences usually occur within the first 2-3 years, and most of the patients die within 15 months after diagnosis of the recurrence.l＇3＇4 The treatment for pelvic recurrence was combined systemic chemotherapy, with a median survival period of 4-7monthsY Here we report a long-term survival case who received intra-arterial chemotherapy as a mono-therapy for pelvic recurrence, which developed 9 months after radical cystectomy.