Comparative Efficacy And Prognosis Of Posterior Laparoscopic Combined With Two Types Of Cystectomy For Upper Urinary Tract Uroepithelial Carcinoma

Purpose: Upper tract urothelial carcinoma(UTUC)is uncommon,accounting for about 5-10% of urothelial carcinomas.With the development of medical technology in recent years,various less invasive surgical methods are used in clinical practice.However,because of the variety of minimally invasive surgical approaches and the lack of studies with large samples and long follow-up,there is currently disagreement on the standard procedure for minimally invasive uroepithelial carcinoma of the upper urinary tract,especially on the treatment of the terminal ureter and ureteral orifice.Therefore,we reviewed patients who underwent posterior laparoscopic nephroureterectomy combined with small lower abdominal cystic cuff resection for UTUC at Shengjing Hospital,China Medical University,and collected patient data to compare and discuss the safety,efficacy,and prognosis of the two surgical approaches.Methods: Patients who underwent posterior laparoscopic radical nephroureterectomy for uroepithelial carcinoma of the upper urinary tract from January 1,2014 to September 1,2022 at Shengjing Hospital of China Medical University were collected and followed up until January 2023 and divided into 128 cystectomies by the extravesical route in group A and 97 cystectomies by the transvesical route in group B according to their specific surgical methods.A comparative study was performed on the above two groups with indicators including the following parts,perioperative indicators such as: operative time,intraoperative blood loss,postoperative hospital stay,etc.Oncological outcomes such as: disease-free survival time,overall survival time,etc.The relevant information was subjected to Cox regression to explore the factors that have an impact on survival time.Results: There were statistically significant differences(P < 0.05)in intraoperative blood loss,duration of pain medication,duration of drainage tube retention,duration of urinary catheter retention,and duration of postoperative hospitalization;the effects of patients’ preoperative serum creatinine value,red blood cell count,alkaline phosphatase value,pathological high grade of the tumor compared with low grade,and postoperative tumor recurrence outside the bladder compared with no recurrence inside the bladder on overall survival time were statistically significant;preoperative The effects of serum creatinine value and pathological high grade of tumor compared to low grade on disease-free survival time were statistically significant.Conclusion: After comparison,it was found that the extravesical route to deal with the bladder cuff had the advantages of less trauma,shorter operative time,faster postoperative recovery,and shorter hospital stay,and no significant differences were seen between the oncological outcomes of the two.Preoperative red blood cell count,alkaline phosphatase,creatinine level,pathological differentiation of the tumor,and tumor recurrence outside the bladder,to some extent,reflect the prognosis of the patient.