Treatment Of Renal Pelvic Cancer With Total Radical Nephrectomy And Total Ureterectomy

ObjectiveRenal pelvic cancer is a common malignant neoplasma in urological and male genital system. In china it accounts for about 24% of all renal tumor and more than the rate of 15% in western countries.The renal pelvic carcinoma is even more common than renal cell carcinoma in Balkan ialand regions.Total nephroectomy is standard treatment for cell carcinoma of kidney, but renal pelvic carcinoma which spead out of perikidney easily underwent only undergoing nephroureterectomy with removal of a bladder cuff.Sixty patients with renal pelvic cancer which confirmed by pathology underwent total nephroureterectomy with iymphrectomy and nephroureterectomy with removal of a bladder cuff , were analysed during 1991-2001 in thedepartment of urology of Medical College,Zhejiang University. All cases were followed-up.The prognosis,lymphtic metastatses and local recurrences of the patients were investigated and the significance of radical nephrectomy and total ureterectomy for renal pelvic carcinoma was evaluated. Material and method60 patients with renal pelvic transitional cell papillary cancer, which were confirmed by the operation and pathology between January ,1991 and March, 2001 in the department of urology,Medical College of Zhejiang University were analysed.Operation style induded two groups:1 total radical nephrectomy and total ureterectomy2 total nephroureterectomy with removal of a bladder cuffAll the data were input to Excel database after they were encoded ,and then read by SPSS 10.0 statistic software. On the univariate analysis ,the cumulative survival rates were calculated by the life-table method using the log rank test for comparison. All tests were performed at the 0.05 level of significances. Statistical analysis were done with the SPSS 10.0 statistic software. We make total analysis of prognosis with pathology and operation factors.Results1. lymphotic nodular metastases were found in total radical nephrectomy and total ureterectomy7 out of 12 patients who underwent total radical nephrectomy and total ureterectomy had lymphotic nodular metastases2. local recurrence4 out of 48 patients with total nephroureterectomy with removal of a bladder cuff had local recurrences, but none patients with total radical nephrectomy and total ureterectomy had local recurrence.3. total three-year and five-year survival rateTotal three-year survival rate was 100%(8/8) in patients with total radical nephrectomy and total ureterectomy,? 1.0%(27/38) in patients with total nephroureterectomy with removal of a bladder cuff respectively. Total five-year survival rate was 33.3%(l/3) and 43.5%(10/23) respectively.4. survival rate in the patients with same pathological gradeWith the same pathological staging (transitional cell papillary carcinoma, grade III and grade IV), three-year survival rate in patients with total nephroureterectomy with removal of a bladder cuff is 0.4861?.1873, but0.7500*0.1531inpatients with totalradicalnephrectomyand total ureterectomy. P value is equal to 0.0492(P<0.05)by univariate analysis.Conclusions1. Total radical nephrectomy and total ureterectomy is better operation style for treatment of high grade renal pelvic carcinoma.2. Total radical nephrectomy and total ureterectomy may reduce the risk of local recurrence.