Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Ioannis Patras, Johan Abrahamsson, Axel Gerdtsson, Martin Nyberg, Ymir Saemundsson, Elin Ståhl, Anne Sörenby, Åsa Warnolf, Johannes Bobjer, Fredrik Liedberg
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引用次数: 0

Abstract

Objective: Disease recurrence, particularly intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), is common. We investigated whether violations of onco-surgical principles before or during RNU, collectively referred to as surgical violation (SV), were associated with survival outcomes.  Material and methods: Data from a consecutive series of patients who underwent RNU for UTUC 2001-2012 at Skåne University Hospital Lund/Malmö were collected. Preoperative insertion of a nephrostomy tube, opening the urinary tract during surgery or refraining from excising the distal ureter were considered as SVs. Survival outcomes in patients with and without SV (IVR-free [IVRFS], disease-specific [DSS] and overall survival [OS]) were assessed using multivariate Cox regression analyses (adjusted for tumour stage group, prior or concomitant bladder cancer, comorbidity and preoperative urinary cytology).

Results: Of 150 patients, 47 (31%) were subjected to at least one SV. Overall, SV was not associated with IVRFS (HR 0.81, 95% CI 0.4-1.6) but with worse DSS (HR 1.9, 95% CI 1.03-3.7) and OS (HR 1.9, 95% CI 1.2-3) in multivariable analysis. Additional analyses with a broader definition of SV including also preoperative instrumentation of the upper urinary tract (ureteroscopy and/or double J stenting) showed similar outcomes for DSS (HR 2.1, 95% CI 1.1-4.3).

Conclusion: Worse survival outcomes, despite no difference in IVR, for patients that were subjected to the violation of sound onco-surgical principles before or during RNU for UTUC strengthen the notion that adhering to such principles is a cornerstone in upper tract urothelial cancer surgery.

违反并行手术原则与上尿路上皮癌根治性肾切除术后的生存结果有关。
目的:上尿路上皮癌(UTUC)根治性肾切除术(RNU)后疾病复发,尤其是膀胱内复发(IVR)很常见。我们研究了在 RNU 之前或过程中违反并行手术原则(统称为手术违规(SV))是否与生存结果有关。 材料与方法我们收集了斯科纳大学隆德/马尔默医院 2001-2012 年因UTUC接受RNU手术的连续系列患者的数据。术前插入肾造瘘管、术中开放尿路或不切除远端输尿管均被视为SV。采用多变量 Cox 回归分析(根据肿瘤分期组别、既往或合并膀胱癌、合并症和术前尿液细胞学进行调整)评估了有 SV 和无 SV 患者的生存结果(无 IVRFS、疾病特异性 DSS 和总生存率 OS):在150名患者中,47人(31%)至少接受了一次SV治疗。总体而言,SV与IVRFS无关(HR 0.81,95% CI 0.4-1.6),但在多变量分析中与较差的DSS(HR 1.9,95% CI 1.03-3.7)和OS(HR 1.9,95% CI 1.2-3)有关。对SV进行了更广泛的定义,包括术前上尿路器械检查(输尿管镜检查和/或双J支架置入术),结果显示DSS结果相似(HR 2.1,95% CI 1.1-4.3):结论:尽管IVR没有差异,但在UTUC的RNU手术前或手术中违反合理的并发症外科原则的患者的生存结果较差,这加强了坚持这些原则是上尿路尿道癌手术的基石这一观点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Scandinavian Journal of Urology
Scandinavian Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.90
自引率
6.70%
发文量
70
期刊介绍: Scandinavian Journal of Urology is a journal for the clinical urologist and publishes papers within all fields in clinical urology. Experimental papers related to clinical questions are also invited.Important reports with great news value are published promptly.
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