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Objective:To investigate the clinical characteristics and prognostic factors of primary urethral cancer.Methods:The clinical data of 35 patients with primary urethral cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to April 2022 were retrospectively analyzed. There were 12 males (34.3%) and 23 females (65.7%). The average age was 61.1 ± 13.0 years old. The clinical symptoms included 13 cases of urethral obstruction (37.1%), 7 cases of hematuria (20.0%), 6 cases of urethral bleeding (17.1%), 5 cases of urinary tract irritation (14.3%), 1 case of Urinary incontinence (2.9%), 1 case of low back pain (2.9%), 1 case of scrotal ulcer (2.9%), and 1 case (2.9%) by self examination. All patients underwent cystourethroscopy and tissue biopsy. The biopsy pathology showed 16 cases of urothelial carcinoma, 7 cases of squamous carcinoma, 4 cases of adenocarcinoma, 3 cases of malignant melanoma, 1 case of urothelial carcinoma with squamous carcinoma, 1 case of Signet ring cell carcinoma, 1 case of sarcomatoid carcinoma, 1 case of embryonic Rhabdomyosarcoma, and 1 case of epithelioid angiosarcoma. The tumors were located in the proximal urethra in 13 cases (37.1%) and in the distal urethra in 22 cases (62.9%). There were 14 cases (40.0%) with a maximum diameter of less than 3 cm, 16 cases (45.7%) with a diameter of ≥ 3 cm, and 5 cases (14.3%) with mucosal abnormalities. There were 12 cases of T 1 stage, 9 cases of T 2 stage, 7 cases of T 3 stage, and 7 cases of T 4 stage in tumor staging. Imaging evaluation of lymph nodes showed 25 cases of N 0 stage, 2 cases of N 1 stage, and 8 cases of N 2 stage; A total of 11 cases of lymph node biopsy were performed (including 8 cases of intraoperative lymph node dissection and 3 cases of preoperative lymph node biopsy), of which 6 cases had lymph node metastasis, and 1 case was initially diagnosed with distant metastasis. Thirty-one cases underwent surgical treatment, of which 16 cases underwent radical urethrectomy, and 8 cases underwent intraoperative pelvic and bilateral inguinal lymph node dissection, 8 cases underwent resection of urethral tumors, and 7 cases underwent transurethral resection of tumors. Four cases did not undergo surgical treatment, while 1 case had epithelioid angiosarcoma and received radiotherapy combined with chemotherapy, 2 cases received chemotherapy with GC (Gemcitabine+ cisplatin) regimen, and 1 case received immunotherapy with immune checkpoint inhibitors. The risk factors that affected patient prognosis were analyzed. Results:All 35 cases in this group were followed up, with a median follow-up time of 22 (2, 122) months. Seventeen cases survived, 18 cases died, and the overall median survival duration was 23 (13 to not reached) months. The overall 5-year survival rate was 45%. The results of univariate analysis showed that clinical T-stage ( P=0.019), maximum tumor diameter ( P=0.016), and tumor location ( P=0.006) were independent risk factors affecting patient prognosis. Result of multivariate analysis showed that the maximum diameter of the tumor ≥ 3 cm ( HR=2.673, P=0.029) and the proximal location of the tumor ( HR=3.064, P=0.023) were independent risk factors affecting patient survival. Gender, age, treatment method, lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, clinical manifestations, pathological type, clinical N staging, and pathological N staging had no significant impact on patient survival rate ( P>0.05). Single factor analysis was conducted on female patients separately, and only tumor location was found to be a prognostic factor ( χ2=17.246, P<0.01). Conclusions:Primary urethral cancer is a rare disease with various symptoms and poor prognosis. The maximum diameter of the tumor ≥3 cm and the tumor located at the proximal end of the urethra are clinical risk factors affecting the prognosis of patients with primary urethral cancer.
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Objective:To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method:The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively. There were 42 males and 47 females and patients’median age was 53 (26-78). Sixty-five cases were treated by operation in our hospital, and 24 cases were primarily treated by the operation in another hospital. The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases, abdominal distension in 12 cases, abdominal pain in 10 cases, fever in 11 cases, nausea, vomiting and poor appetite in 8 cases, frequent urination and dysuria in 6 cases, and bilateral lower limb edema in 1 case. Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases, while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases. There were 55 single cases and 34 multiple cases. The median tumor length was 20(3-52) cm. Among the primarily treated 65 patients, 47(72.3%) were considered as primary retroperitoneal liposarcoma by preoperative imaging examination. Among the 89 patients treated by surgery, 78 underwent endoscopic surgery, among which 21 underwent laparoscopic surgery, 38 cases of retroperitoneal laparoscopic surgery, 19 cases of Da Vinci robot-assisted laparoscopic surgery. Open operation was performed in 11 cases. There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection. Forty-two patients underwent intraoperative combined resection of the adjacent organs. The recurrence and survival status of patients were followed up.Results:All the 89 patients underwent the operation successfully, with the median operative blood loss of 200 (10-2000) ml. There were 23 cases being diagnosed of well differentiated liposarcoma, 40 cases of dedifferentiated, 20 cases of myxoid/round, 5 cases of myxoid liposarcoma, and 1 cases of mixed type. Pathologically, there 42 cases with low grade histology and 47 cases with high grade histology. In this study, 89 patients were followed up for 3 to 108 months, and the median follow-up time was 28 months. The 5-year recurrence free survival rate, disease-free survival rate and overall survival rate of the patients were 16.7%, 16.1% and 52.6%, respectively. There were 57 patients presenting local recurrence, 1 patient of lung metastasis, and 1 patient of liver metastasis, and the median disease-free survival time was 24 months. There were 42 patients died of the disease, with a median survival time of 64 months. Univariate analysis showed that intraoperative blood loss( P<0.01), whether multiple cases( P<0.01), pathologic types( P<0.01), and histological grades ( P<0.01) were related to disease-free survival.The intraoperative blood loss( P<0.01), multiple cases( P<0.05), pathologic types ( P<0.05), and recurrence ( P<0.01)were related with overall survival. Gender, age, tumor size, tumor location, whether primary surgery, radical resection or combined resection of adjacent organ had no effect on the prognosis of patients ( P>0.05). Cox regression model multivariate analysis revealed that surgical bleeding ( RR=2.360, 95% CI 1.313-4.241, P=0.004), multiple tumor ( RR=1.899, 95% CI 1.068-3.375, P=0.029), and pathological type ( RR=4.976, 95% CI 1.622-15.264, P=0.005) were independent factors affecting disease-free survival. The recurrence was an independent factor affecting the overall survival of patients ( RR=31.495, 95% CI 1.062-933.684, P=0.046). Conclusions:Retroperitoneal liposarcoma is a rare disease with high recurrence rate. The intraoperative blood loss, whether multiplicity and pathological type are independent factors affecting the disease-free survival, and recurrence is independent factors affecting the overall survival.
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Objective:To investigate the efficacy and safety of transperitoneal robot-assisted nephroureterectomy (RANU) with a single body position and original ports for upper urinary tract urothelial carcinoma(UTUC).Methods:Clinical data of 21 patients from March 2018 to November 2019 in the First Affiliated Hospital of Zhengzhou University was retrospectively analyzed, including 14 males and 7 females. The age was (63.8±11.4) years and the BMI was (23.6±2.5) kg/m 2.Of the 21 localized UTUC patients, 8 pelvic tumors, 3 middle ureter tumors, 10 lower ureter tumors; 11 on the left, 10 on the right; 20 of 21 tumors (95.2%) were high risk. Surgery was done by the same urologist. Under general anesthesia, the patients were in 75 ° healthy side lying position and overall 15 ° head down and foot high position. Improved layout of ports: camera port C was located at two fingers lateral to the umbilicus, 2 cm below the umbilicus; robotic arm port 1 and 2 were respectively located at pararestus line, close to costal margin and 2 cm below the midpoint between C and the affected iliac crest. Assistant port 1 and 2 were respectively located at 2 cm above the umbilicus and 4 cm below the umbilicus. The right cases need an additional assistant port under the xiphoid to provoke the liver. Hem-o-lok cliped the ureter distal to the tumor and the affected kidney was radically removed. Under the principle of tumor free, the ureter and the surrounding bladder wall within 1 cm were excised and the bladder was sutured. Lymphadenectomy was performed when the kidney and ureter were dissociated. Results:All 21 procedures were successful without open surgery or position change and intraoperative complications. No patients required a blood transfusion. The operation time was (205.2±57.3) min. The median intraoperative blood loss was 50 ml (20-120 ml). The median drainage tube indwelling time was 4d(3-7 d) and the median urinary catheter indwelling time was 7 d(5-8 d), the median postoperative hospital stay was 7 d(6-12 d).7 cases(33.3%)of Clavien-Dindo grade Ⅰ complications after surgery and they all relieved after giving symptomatic treatment. All postoperative pathology showed UTUC and negative resection margins. The median follow-up time was 12 months (4-22 months), 1 patient died of an accident 7 months after surgery and 3 patients had recurrence at 6, 8, and 10 months after surgery, survival at the last follow-up after treatment.Conclusions:The transperitoneal RANU with a single body position and original ports is safe and effective. The operation time is saved, the incidence of intraoperative and postoperative complications is low, the postoperative patients recover quickly.Short-term follow-up results prompt low recurrence rate and good tumor control effect.