Preventing strategies of bladder cancer recurrence after surgery for upper tract urothelial carcinoma / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the methods for preventing bladder cancer recurrence after surgical treatment for upper tract urothelial carcinoma.Methods Of the 156 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary trace,139 were followed up and their data were retrospectively analyzed.Of the 139 cases,78 had pyelic carcinoma and 61 had ureteral carcinoma.The tumor cell grading showed G_1 in 19 cases,G_2 in 88 and G_3 in 32.The tumor staging showed T_a-T_1 in 38 cases,T_2 in 80 and T_3-T_4 in 21.The tumor diameter ranged from 0.8 to 6.0 cm.Results Radical nephroureterectomy and resection of partial bladder wall around the ureteral orifice(1.5-2.0 cm) were performed in all the 139 patients;of whom 55(39.6%) experienced subsequent bladder cancer recurrence during a mean follow-up of 52 months(range,1-10 years).The bladder cancer recurrence rate was 18.5%(5/27) in patients whose ureter had been ligated before the kidney was dissociated;and the recurrence rate was 27.5%(14/51) in patients whose ureter had not been firstly ligated.The recurrence rates in those who had prophylactic intravesical instillation immediately after surgery and in those who had the instillation 3 weeks after surgery were 32.3%(10/31) and 34.9%(30/86),respectively.The recurrence rate was 20.0%(4/20) in those who had intravesical instillation on the surgical day and 3 weeks after surgery sequentially,which was significantly lower than that(39.3%,26/66) in those who had the instillation simply 3 weeks after surgery(P