Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was sched...Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).展开更多
Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive ...Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.展开更多
Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pe...Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pelvic incision.To decrease morbidity,urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy.In many published series of laparoscopic nephroureterectomy,the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the“pluck”technique,with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage.While the distal ureter and bladder cuff can be excised laparoscopically,it does require advanced laparoscopic skills.With the wrist articulation and stereoscopic vision in robotic surgery,robotic nephroureterectomy(RNU)and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight,mucosa to mucosa fashion after excising the bladder cuff.In this review,we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.展开更多
Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at...Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.展开更多
BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classi...BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)method.Even though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic outcomes.AIM To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC patients.METHODS We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December 2018.Patients were analyzed according to each BCE method.Data extracted included patient demographics,perioperative parameters,and oncological outcomes.Statistical analyses were performed using chi-square and log-rank tests.The Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically significant.RESULTS Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)TUBC.At a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,respectively.Cancer-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,respectively.Kaplan-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,respectively.Multivariate analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influenced by tumor stage(hazard ratio[HR]=8.439;95%condence interval:2.424-29.377;P=0.001)and lymph node status(HR=14.343;95%CI:5.176-39.745;P<0.001).CONCLUSION All three techniques had comparable outcomes;although,EVBC and TUBC are minimally invasive.While based upon rather limited data,these findings will support urologists in blending experience with evidence to inform patient choices.However,larger,rigorously designed,multicenter studies with long term outcomes are still required.展开更多
Objective:To evaluate the prognostic value of platelet-to-lymphocyte ratio(PLR)in upper tract urothelial carcinoma(UTUC)patients treated with radical nephroureterectomy.Methods:This study was pre-registered in PROSPER...Objective:To evaluate the prognostic value of platelet-to-lymphocyte ratio(PLR)in upper tract urothelial carcinoma(UTUC)patients treated with radical nephroureterectomy.Methods:This study was pre-registered in PROSPERO(No.CRD42020186645).Two reviewers independently performed a comprehensive literature search on PubMed,Web of Science,EMBASE,Cochrane Library databases,China Biology Medicine disc(CBM),Wanfang database,and China National Knowledge Infrastructure(CNKI)from inception to May 2021 for prospective or retrospective cohort studies evaluating the prognostic value of PLR.Literature was analyzed with inclusion and exclusion criteria.Data and other useful clinicopathological features were extracted and analyzed with fixed or random-effect models when applicable.Heterogeneity was assessed on the basis of Cochran’s Q test and I2 statistic.Publication bias was assessed with funnel plots and precisely assessed by Egger's tests.Results:A total of ten studies involving 3287 UTUC patients were included.Meta-analysis showed that elevated preoperative PLR was associated with worse overall survival(HR=1.51,95%CI 1.17-1.94,P=0.001),cancer specific survival(HR=1.52,95%CI 1.21-1.90,P<0.001),disease free survival(HR=1.32,95%CI 1.12-1.56,P=0.001),and progression free survival(HR=1.88,95%CI 1.41-2.52,P<0.001).Furthermore,the sensitivity analyses validated the stability and reliability of the results.Conclusion:The present meta-analysis demonstrates a significant association between elevated preoperative PLR and poor prognosis of UTUC patients treated with radical nephroureterectomy.Hence,PLR could be helpful as a potential prognostic biomarker to guide clinical decision-making and select individualized treatment strategies for UTUC patients.However,more prospective and large-scale trials are needed to provide more evidence.展开更多
Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multip...Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma.Methods:Between January 2021 and October 2024,our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU(n�31)or the conventional multi-port laparoscopic nephroureterectomy(LNU)(n�25)via the retroperitoneal approach.Data including demographic,perioperative,pathological,and oncological characteristics were collected.Results:No significant differences were found in patient demographics and tumor characteristics between the two groups.No serious intraoperative complications occurred in both groups.The mean operation time,skin incision length,Visual Analog Scale pain scores,time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min,6.48 cm and 15.40 cm,3.23 and 4.60,5.71 min and 30.24 min,and 10.84 months and 22.88 months,respectively(p<0.001).There were no significant differences in other perioperative data between the two groups.Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group(p<0.001).The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients(130.33 min vs.145.31 min,p=0.044).There were no significant differences in the pathological characteristics between the two groups.Recurrences developed in four patients:one in the LESS-RANU group and three in the LNU group.-Conclusion:LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach,especially for patients with low body mass index.展开更多
Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(U...Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database.Patients undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study population.Patients with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were excluded.Tabulation was performed according to the laparoscopic versus open surgical approach.Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach.Furthermore,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.Results:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open nephroureterectomy.Patient and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),respectively.The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.Conclusions:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU.Furthermore,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.展开更多
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 pr...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.展开更多
Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients ...Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients with enormous invasion related to large morbidity,delayed gastrointestinal function,and late recovery.1 This study reports the largest series of minimally invasive procedures of simultaneous bilateral retroperitoneoscopic nephroureterectomy （SBRNU） via a midline lower abdominal incision in renal recipients.展开更多
Background From limited exposure with management of the native distal ureter ipsilateral to the transplanted kidney, we usually choose open nephroureterectomy （NU） or laparoscopic NU combined with an open approach i...Background From limited exposure with management of the native distal ureter ipsilateral to the transplanted kidney, we usually choose open nephroureterectomy （NU） or laparoscopic NU combined with an open approach in renal transplant （RTx） recipients. We herein describe our preliminary experience with total endoscopic NU with bladder cuff （BC） excision and evaluate its feasibility for RTx recipients.展开更多
Objectives:To explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.Methods:Forty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies fo...Objectives:To explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.Methods:Forty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014.The patients consisted of 53 males and 30 females with a mean age of 36 years (range:26-51 years).The patients' data were reviewed and analyzed.Results:The retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery.The mean operating time was 170 minutes (range:121-258 minutes),the mean blood loss was 110 ml (range:70-250 ml),and the mean hospital stay was 5.70 days (range:5-14 days); these were all much less than nephroureterectomy procedures (P ＜ 0.05).A total of five minor complications (10.4％) occurred,injury to the peritoneum was observed in three patients,and infection at the incision site was observed in two patients,there were no obvious difference between the two surgical methods (P ＞ 0.05).Seventy-five patients were followed up,and the average follow-up time was 12.5 months (range:6-20 months).All the patients recovered without any lesions remaining.Conclusions:The results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible,safe,effective,and less invasive treatment modality for treating renal tuberculosis.展开更多
Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radi...Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.展开更多
Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore th...Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy(RNU),a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center(West China Hospital,Chengdu,China)were included in this study.Kaplan-Meier method and Cox regressi on an a lyses were performed to assess the relationship betwee n Cys-C and survival outcomes using SPSS versi on 22.0.The cutoff value of Cys-C was set as 1.4 mg I1 using the receiver operating characteristic(ROC)curves and Youden index.The mean age of patients included was 66.1±11.1 years,and the media n follow-up durati on was 38(interquartile ran ge:19-56)mon ths.Overall,162(30.1%)patients had elevated Cys-C,and they were much older and had worse renal function than those with Cys-C<1.4 mg I^-1(both P<0.001).Meanwhile,Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival(CSS,P=0.001),disease recurrence-free survival(RFS,P=0.003),and overall survival(OS,P<0.001).Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS(hazard ratio[HR]:1.997,95%confidential interval[CI]:1.331-2.996),RFS(HR:1.429,95%CI:1.009-2.023),and OS(HR:1.989,95%CI:1.366-2.896).In conclusion,our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.展开更多
Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper...Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper urinary tract-LELC cases which provided insight into this disease;however,the current evidence does not provide clinicians with clear guidelines due to its rarity.Therefore,the aim was to report a new case of renal pelvis LELC presented in our hospital.In this instance,we were able to report treatment experience and longterm follow-up results.This patient presented with hypertension and haemturia which initiated further investigation.While ultrasound identified an hypechoic mass,no malignant cells were detected using cytological testing.Abdominal magnetic resonance imaging identified a slightly enhanced mass in the left renal pelvis with no evidence of lymph node metastasis.Ureteroscopic tumor biopsy suggested the existence of urothelial carcinoma,hence,laparoscopic radical left nephroureterectomy with bladder cuff excision was performed.Through patientpractitioner consultations,we decided to adopt a"watch and wait"approach after radical nephroureterectomy rather than administering chemotherapy.Although,we would encourage clinicians to record and publish cases to garner insight into this type of malignant disease.展开更多
Renal tumor surgery places patients at increased risk for chronic kidney disease(CKD). Accurate quantification of kidney function changes before and after surgery is essential to determine the magnitude of decline att...Renal tumor surgery places patients at increased risk for chronic kidney disease(CKD). Accurate quantification of kidney function changes before and after surgery is essential to determine the magnitude of decline attributable to an index procedure. Current literature, however, highlights heterogeneity and inconsistencies in measurement techniques thereby contributing to ambiguity amongst studies. Further efforts are necessary to standardize reporting of kidney function outcomes related to renal surgery.展开更多
BACKGROUND Ureteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction.However,they are sometimes forgotten and the risk of complications increa...BACKGROUND Ureteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction.However,they are sometimes forgotten and the risk of complications increases with time.CASE SUMMARY A 43-year-old woman with a history of recurrent urinary tract infections visited our hospital for evaluation of persistent left flank pain,and lower urinary tract symptoms despite anti-biotic treatment.She had received urological surgery in her teens but did not know the details of her surgery.Kidney,ureter,and bladder X-ray and abdominopelvic computed tomography revealed a forgotten left ureteral stent with huge encrustation at both ends and a severely dilated left kidney with parenchymal thinning.In order to remove the ureteral stent,a laparoscopic nephroureterectomy was planned.The ureteral stent was successfully removed,and she was discharged after recovery.The patient was followed up for two years after surgery and did not show any signs of long-term complications.CONCLUSION Long indwelling stents can cause dire complications requiring radical interventions.Stent registry systems,novel stent material development,and proper patient education is important for complication prevention.展开更多
BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although L...BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.展开更多
This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma(UTUC)in a large Chinese cohort.A total of 703 patients who underwent radical nephroureterectomy were retrospec...This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma(UTUC)in a large Chinese cohort.A total of 703 patients who underwent radical nephroureterectomy were retrospectively identified.Fibrinogen levels of≥4.025 g l?1 were defined as elevated.Logistic regression analysis was performed to determine the association between fibrinogen and adverse pathological features.Kaplan–Meier analysis and Cox regression models were used to assess the associations of fibrinogen with cancer-specific survival(CSS),disease recurrence-free survival(RFS),and overall survival(OS).Harrell c-index and decision curve analysis were used to assess the clinical utility of multivariate models.The median follow-up duration was 42(range:1–168)months.Logistic regression analysis revealed that elevated fibrinogen was associated with higher tumor stage and grade,lymph node involvement,lymphovascular invasion,sessile carcinoma,concomitant variant histology,and positive surgical margins(all P<0.05).Multivariate Cox regression analysis demonstrated that elevated fibrinogen was independently associated with decreased CSS(hazard ratio[HR]:2.33;P<0.001),RFS(HR:2.09;P<0.001),and OS(HR:2.09;P<0.001).The predictive accuracies of the multivariate models were improved by 3.2%,2.0%,and 2.8%for CSS,RFS,and OS,respectively,when fibrinogen was added.Decision curve analysis showed an added benefit for CSS prediction when fibrinogen was added to the model.Preoperative fibrinogen may be a strong independent predictor of worse oncologic outcomes in UTUC;therefore,it may be valuable to apply this marker to the current risk stratification in UTUC.展开更多
Objective:Once chronic inflammatory renal disease(IRD)develops,it creates a severe peri-fibrotic process,which makes it a relative contraindication for minimally invasive surgery(MIS).Our objective is to show that lap...Objective:Once chronic inflammatory renal disease(IRD)develops,it creates a severe peri-fibrotic process,which makes it a relative contraindication for minimally invasive surgery(MIS).Our objective is to show that laparoscopic nephrectomy(LN)is a surgical option in IRD with fewer complications and better outcomes.Methods:Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed.Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition(xanthogranulomatous pyelonephritis,chronic nephritis,and renal tuberculosis).We describe intra-operative variables such as operative time,blood loss,conversion rate,postoperative complications and length of hospital stay.Results:There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD.We identified four(8%)major complications;three of them required transfusion and one conversion to open surgery.The mean operative time was 233108 min.Mean estimated blood loss was 206242 mL excluding the conversion cases and 281423 mL including them.The mean length of hospital stay was 3.02.0 days.Conclusion:Laparoscopic nephrectomy for IRD can safely be done.It is a reproducible technique with low risks and complication rates.Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.展开更多
文摘Dear Editor,We aimed to describe the management of the intraoperative injury of the right external iliac artery that occurred during robot-assisted right nephroureterectomy with bladder cuff excision.Surgery was scheduled for suspected urothelial carcinoma of the distal ureter in a 60-year-old woman.The patient involved in the present research signed a dedicated form to consent to the publication of images and/or information about her.Past medical history included Brugada syndrome diagnosed in 2015,and hypercholesterolemia.Past surgical history included one cesarean section only.Family history included ovarian cancer(sister),colorectal cancer(mother),and kidney cancer(father).
文摘Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.
文摘Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pelvic incision.To decrease morbidity,urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy.In many published series of laparoscopic nephroureterectomy,the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the“pluck”technique,with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage.While the distal ureter and bladder cuff can be excised laparoscopically,it does require advanced laparoscopic skills.With the wrist articulation and stereoscopic vision in robotic surgery,robotic nephroureterectomy(RNU)and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight,mucosa to mucosa fashion after excising the bladder cuff.In this review,we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.
文摘Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
基金Supported by the Capital Clinical Characteristics Applications Research Program,No.Z171100001017201the Beijing Hospital Clinical Research 121 Project,No.BJ-2018-090the Beijing Hospital Clinical Research,No.BJ-2015-098.
文摘BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)method.Even though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic outcomes.AIM To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC patients.METHODS We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December 2018.Patients were analyzed according to each BCE method.Data extracted included patient demographics,perioperative parameters,and oncological outcomes.Statistical analyses were performed using chi-square and log-rank tests.The Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically significant.RESULTS Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)TUBC.At a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,respectively.Cancer-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,respectively.Kaplan-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,respectively.Multivariate analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influenced by tumor stage(hazard ratio[HR]=8.439;95%condence interval:2.424-29.377;P=0.001)and lymph node status(HR=14.343;95%CI:5.176-39.745;P<0.001).CONCLUSION All three techniques had comparable outcomes;although,EVBC and TUBC are minimally invasive.While based upon rather limited data,these findings will support urologists in blending experience with evidence to inform patient choices.However,larger,rigorously designed,multicenter studies with long term outcomes are still required.
基金National Natural Science Foundation of China(81970662)Key Research and Development of Shanxi Province(201803D31110)the Shanxi‘1331 Project’key Innovation Team Construction Plan(3c332019001)。
文摘Objective:To evaluate the prognostic value of platelet-to-lymphocyte ratio(PLR)in upper tract urothelial carcinoma(UTUC)patients treated with radical nephroureterectomy.Methods:This study was pre-registered in PROSPERO(No.CRD42020186645).Two reviewers independently performed a comprehensive literature search on PubMed,Web of Science,EMBASE,Cochrane Library databases,China Biology Medicine disc(CBM),Wanfang database,and China National Knowledge Infrastructure(CNKI)from inception to May 2021 for prospective or retrospective cohort studies evaluating the prognostic value of PLR.Literature was analyzed with inclusion and exclusion criteria.Data and other useful clinicopathological features were extracted and analyzed with fixed or random-effect models when applicable.Heterogeneity was assessed on the basis of Cochran’s Q test and I2 statistic.Publication bias was assessed with funnel plots and precisely assessed by Egger's tests.Results:A total of ten studies involving 3287 UTUC patients were included.Meta-analysis showed that elevated preoperative PLR was associated with worse overall survival(HR=1.51,95%CI 1.17-1.94,P=0.001),cancer specific survival(HR=1.52,95%CI 1.21-1.90,P<0.001),disease free survival(HR=1.32,95%CI 1.12-1.56,P=0.001),and progression free survival(HR=1.88,95%CI 1.41-2.52,P<0.001).Furthermore,the sensitivity analyses validated the stability and reliability of the results.Conclusion:The present meta-analysis demonstrates a significant association between elevated preoperative PLR and poor prognosis of UTUC patients treated with radical nephroureterectomy.Hence,PLR could be helpful as a potential prognostic biomarker to guide clinical decision-making and select individualized treatment strategies for UTUC patients.However,more prospective and large-scale trials are needed to provide more evidence.
基金supported by the Key Medical Scientific Research Project of the Jiangsu Commission of Health(No.ZD2021028 to Zhu Q)the General Project of the Medical Scientific Research of the Jiangsu Commission of Health(No.Z2021074 to Shen L).
文摘Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma.Methods:Between January 2021 and October 2024,our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU(n�31)or the conventional multi-port laparoscopic nephroureterectomy(LNU)(n�25)via the retroperitoneal approach.Data including demographic,perioperative,pathological,and oncological characteristics were collected.Results:No significant differences were found in patient demographics and tumor characteristics between the two groups.No serious intraoperative complications occurred in both groups.The mean operation time,skin incision length,Visual Analog Scale pain scores,time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min,6.48 cm and 15.40 cm,3.23 and 4.60,5.71 min and 30.24 min,and 10.84 months and 22.88 months,respectively(p<0.001).There were no significant differences in other perioperative data between the two groups.Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group(p<0.001).The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients(130.33 min vs.145.31 min,p=0.044).There were no significant differences in the pathological characteristics between the two groups.Recurrences developed in four patients:one in the LESS-RANU group and three in the LNU group.-Conclusion:LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach,especially for patients with low body mass index.
文摘Objectives:To test for differences in overall and recurrence-free survival between laparoscopic and open surgical approaches in patients undergoing radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC).Materials and methods:We retrospectively identified patients treated for UTUC from 2010 to 2020 from our institutional database.Patients undergoing laparoscopic or open RNU with no suspicion of metastasis(cM0)were for the current study population.Patients with suspected metastases at diagnosis(cM1)or those undergoing other surgical treatments were excluded.Tabulation was performed according to the laparoscopic versus open surgical approach.Kaplan-Meier plots were used to test for differences in overall and recurrence-free survival with regard to the surgical approach.Furthermore,separate Kaplan-Meier plots were used to test the effect of preoperative ureterorenoscopy on overall and recurrence-free survival within the overall study cohort.Results:Of the 59 patients who underwent nephroureterectomy,29%(n=17)underwent laparoscopic nephroureterectomy,whereas 71%(n=42)underwent open nephroureterectomy.Patient and tumor characteristics were comparable between groups(p≥0.2).The median overall survival was 93 and 73 months in the laparoscopic nephroureterectomy group compared to the open nephroureterectomy group(p=0.5),respectively.The median recurrence-free survival did not differ between open and laparoscopic nephroureterectomies(73 months for both groups;p=0.9).Furthermore,the median overall and recurrence-free survival rates did not differ between patients treated with and without preoperative ureterorenoscopy.Conclusions:The results of this retrospective,single-center institution showed that overall and recurrence-free survival rates did not differ between patients with UTUC treated with laparoscopic and open RNU.Furthermore,preoperative ureterorenoscopy before RNU was not associated with higher overall or recurrence-free survival rates.
基金This study was supported by a grant from-the National Natural Science Foundation of China （No. 81072101/H1619）.
文摘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.
文摘Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients with enormous invasion related to large morbidity,delayed gastrointestinal function,and late recovery.1 This study reports the largest series of minimally invasive procedures of simultaneous bilateral retroperitoneoscopic nephroureterectomy （SBRNU） via a midline lower abdominal incision in renal recipients.
文摘Background From limited exposure with management of the native distal ureter ipsilateral to the transplanted kidney, we usually choose open nephroureterectomy （NU） or laparoscopic NU combined with an open approach in renal transplant （RTx） recipients. We herein describe our preliminary experience with total endoscopic NU with bladder cuff （BC） excision and evaluate its feasibility for RTx recipients.
文摘Objectives:To explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.Methods:Forty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014.The patients consisted of 53 males and 30 females with a mean age of 36 years (range:26-51 years).The patients' data were reviewed and analyzed.Results:The retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery.The mean operating time was 170 minutes (range:121-258 minutes),the mean blood loss was 110 ml (range:70-250 ml),and the mean hospital stay was 5.70 days (range:5-14 days); these were all much less than nephroureterectomy procedures (P ＜ 0.05).A total of five minor complications (10.4％) occurred,injury to the peritoneum was observed in three patients,and infection at the incision site was observed in two patients,there were no obvious difference between the two surgical methods (P ＞ 0.05).Seventy-five patients were followed up,and the average follow-up time was 12.5 months (range:6-20 months).All the patients recovered without any lesions remaining.Conclusions:The results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible,safe,effective,and less invasive treatment modality for treating renal tuberculosis.
文摘Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.
基金the National Key Research and Development Program of China(Grant No.SQ2017YFSF090096)the Prostate Cancer Foundation Young Investigator Award 2013,the National Natural Science Foundation of China(Grant No.81300627,81370855,81702536,and 81770756)+1 种基金the Science and Technology Department of Sichuan Province(Grant No.2014JY0219 and 2017HH0063)Young Investigator Award of Sichuan University 2017.The funders had no role in patient selection,data extraction,statistical analysis or interpretation,writing of this article,or the decision to publish.
文摘Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy(RNU),a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center(West China Hospital,Chengdu,China)were included in this study.Kaplan-Meier method and Cox regressi on an a lyses were performed to assess the relationship betwee n Cys-C and survival outcomes using SPSS versi on 22.0.The cutoff value of Cys-C was set as 1.4 mg I1 using the receiver operating characteristic(ROC)curves and Youden index.The mean age of patients included was 66.1±11.1 years,and the media n follow-up durati on was 38(interquartile ran ge:19-56)mon ths.Overall,162(30.1%)patients had elevated Cys-C,and they were much older and had worse renal function than those with Cys-C<1.4 mg I^-1(both P<0.001).Meanwhile,Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival(CSS,P=0.001),disease recurrence-free survival(RFS,P=0.003),and overall survival(OS,P<0.001).Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS(hazard ratio[HR]:1.997,95%confidential interval[CI]:1.331-2.996),RFS(HR:1.429,95%CI:1.009-2.023),and OS(HR:1.989,95%CI:1.366-2.896).In conclusion,our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.
基金Supported by the Capital Clinical Characteristics Applications Research Program,No.Z171100001017201the Beijing Hospital Clinical Research 121Project,No. BJ-2018-090.
文摘Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper urinary tract-LELC cases which provided insight into this disease;however,the current evidence does not provide clinicians with clear guidelines due to its rarity.Therefore,the aim was to report a new case of renal pelvis LELC presented in our hospital.In this instance,we were able to report treatment experience and longterm follow-up results.This patient presented with hypertension and haemturia which initiated further investigation.While ultrasound identified an hypechoic mass,no malignant cells were detected using cytological testing.Abdominal magnetic resonance imaging identified a slightly enhanced mass in the left renal pelvis with no evidence of lymph node metastasis.Ureteroscopic tumor biopsy suggested the existence of urothelial carcinoma,hence,laparoscopic radical left nephroureterectomy with bladder cuff excision was performed.Through patientpractitioner consultations,we decided to adopt a"watch and wait"approach after radical nephroureterectomy rather than administering chemotherapy.Although,we would encourage clinicians to record and publish cases to garner insight into this type of malignant disease.
文摘Renal tumor surgery places patients at increased risk for chronic kidney disease(CKD). Accurate quantification of kidney function changes before and after surgery is essential to determine the magnitude of decline attributable to an index procedure. Current literature, however, highlights heterogeneity and inconsistencies in measurement techniques thereby contributing to ambiguity amongst studies. Further efforts are necessary to standardize reporting of kidney function outcomes related to renal surgery.
基金Supported by Kyung Hee University in 2018No.KHU-20182183.
文摘BACKGROUND Ureteral stent insertion is a relatively non-invasive procedure commonly used in the field of urology to resolve urinary obstruction.However,they are sometimes forgotten and the risk of complications increases with time.CASE SUMMARY A 43-year-old woman with a history of recurrent urinary tract infections visited our hospital for evaluation of persistent left flank pain,and lower urinary tract symptoms despite anti-biotic treatment.She had received urological surgery in her teens but did not know the details of her surgery.Kidney,ureter,and bladder X-ray and abdominopelvic computed tomography revealed a forgotten left ureteral stent with huge encrustation at both ends and a severely dilated left kidney with parenchymal thinning.In order to remove the ureteral stent,a laparoscopic nephroureterectomy was planned.The ureteral stent was successfully removed,and she was discharged after recovery.The patient was followed up for two years after surgery and did not show any signs of long-term complications.CONCLUSION Long indwelling stents can cause dire complications requiring radical interventions.Stent registry systems,novel stent material development,and proper patient education is important for complication prevention.
文摘BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.
基金This program was supported by the National key Research and Development program of China(Grant No.SQ2017YFSF090096)the Prostate Cancer Foundation Young Investigator Award 2013,the National Natural Science Foundation of China(Grant No.81300627,No.81370855,No.81702536,and No.81770756)+1 种基金Programs from Science and Technology Department of Sichuan Province(Grant No.2018JY0089 and No.2017HH0063)Young Investigator Award of Sichuan University 2017(Grant No.2017SCU04A17).The funders had no role in patient selection,data extraction,statistical analysis or interpretation,writing of this article,or the decision to publish.
文摘This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma(UTUC)in a large Chinese cohort.A total of 703 patients who underwent radical nephroureterectomy were retrospectively identified.Fibrinogen levels of≥4.025 g l?1 were defined as elevated.Logistic regression analysis was performed to determine the association between fibrinogen and adverse pathological features.Kaplan–Meier analysis and Cox regression models were used to assess the associations of fibrinogen with cancer-specific survival(CSS),disease recurrence-free survival(RFS),and overall survival(OS).Harrell c-index and decision curve analysis were used to assess the clinical utility of multivariate models.The median follow-up duration was 42(range:1–168)months.Logistic regression analysis revealed that elevated fibrinogen was associated with higher tumor stage and grade,lymph node involvement,lymphovascular invasion,sessile carcinoma,concomitant variant histology,and positive surgical margins(all P<0.05).Multivariate Cox regression analysis demonstrated that elevated fibrinogen was independently associated with decreased CSS(hazard ratio[HR]:2.33;P<0.001),RFS(HR:2.09;P<0.001),and OS(HR:2.09;P<0.001).The predictive accuracies of the multivariate models were improved by 3.2%,2.0%,and 2.8%for CSS,RFS,and OS,respectively,when fibrinogen was added.Decision curve analysis showed an added benefit for CSS prediction when fibrinogen was added to the model.Preoperative fibrinogen may be a strong independent predictor of worse oncologic outcomes in UTUC;therefore,it may be valuable to apply this marker to the current risk stratification in UTUC.
文摘Objective:Once chronic inflammatory renal disease(IRD)develops,it creates a severe peri-fibrotic process,which makes it a relative contraindication for minimally invasive surgery(MIS).Our objective is to show that laparoscopic nephrectomy(LN)is a surgical option in IRD with fewer complications and better outcomes.Methods:Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed.Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition(xanthogranulomatous pyelonephritis,chronic nephritis,and renal tuberculosis).We describe intra-operative variables such as operative time,blood loss,conversion rate,postoperative complications and length of hospital stay.Results:There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD.We identified four(8%)major complications;three of them required transfusion and one conversion to open surgery.The mean operative time was 233108 min.Mean estimated blood loss was 206242 mL excluding the conversion cases and 281423 mL including them.The mean length of hospital stay was 3.02.0 days.Conclusion:Laparoscopic nephrectomy for IRD can safely be done.It is a reproducible technique with low risks and complication rates.Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.
