medigraphic.com
ISSN 2305-7939 (Digital)

2015, Número 1

<< Anterior Siguiente >>

RCU 2015; 4 (1)


Cirugía laparoscópica de los tumores del urotelio del tracto urinario superior

González LT, Moreira M, Bautista ODJ, Suárez MME, Perdomo LD, Rodríguez-Ojea L, Hernández CJL

Idioma: Español
Referencias bibliográficas: 35
Paginas: 5-14
Archivo PDF: 892.30 Kb.


RESUMEN

Introducción: los tumores del urotelio del tracto urinario superior son poco comunes. La nefroureterectomía con resección del rodete vesical es el tratamiento de elección en los tumores del urotelio del tracto urinario superior músculo-invasivos, no metastásicos. La nefroureterectomia laparoscópica ha mostrado mejores resultados perioperatorios que la cirugía abierta, pero su eficacia oncológica ha sido discutida. Objetivo: describir los resultados de la nefroureterectemía laparoscópica en los tumores del tracto urinario superior, en el Centro Nacional de Cirugía de Mínimo Acceso. Método: se realizó un estudio descriptivo, retrospectivo, en una serie de 89 pacientes pacientes tratados por tumores del tracto urinario superior, mediante cirugía laparoscópica, desde enero de 2006 hasta abril de 2014, de los cuales, a 11 se les realizó nefroureterectomía laparoscópica. Se emplearon abordajes lumboscópico y transperitoneal con mano-asistencia. Resultados: la edad promedio fue 69,5 años. Predominó el sexo masculino y el estado físico preoperatorio ASA I (81,81 %). El 63,63 % consultó por hematuria. Predominaron los tumores de la pelvis (72,72 %). En el 54,54 % se empleó el abordaje lumboscópico. En todos se realizó la ureterectomía distal abierta, mediante cirugía abierta. El tiempo quirúrgico promedio fue 234,1 minutos y el sangrado de 237,7 ml. Se produjo una complicación postoperatoria grado I. Predominaron los estadios T1 y T2 (54,54 %). El tipo histológico, en el 90,9% de los pacientes, fue tumor de células transicionales. La supervivencia fue 90 %, en un tiempo de seguimiento promedio de 28,27 meses (3-56 meses). Dos pacientes (18,18 %) desarrollaron recurrencia vesical. Conclusiones: la cirugía laparoscópica de los tumores del urotelio superior ha sido factible con resultados oncológicos y perioperatorios satisfactorios.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Smith P, Mandel J, Raman JD. Conservative nephron-sparing treatment of upper-tract tumors. Curr Urol Rep. 2013; 14(2):102-8.

  2. Liatsikos E, Kallidonis P, Do M, Dietel A, Al-Aown A, Constantinidis C, et al. Laparoscopic radical and partial nephrectomy: technical issues and outcome. World J Urol. 2013; 31(4):785-91.

  3. Hanna N, Sun M, Trinh Q-D, Hansen J, Bianchi M, Montorsi F et al. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol. 2012; 6 (4):715-21.

  4. Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991; 1(6): 343-9.

  5. Chung SD, Tsai YC, Chen KH. Ricardo L. Favaretto A, Shahrokh F, Shariat A, Daher C, Chade A, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol. 2011 Jan; 59(1):e3. doi: 10.1016/j.eururo.2010.10.025. Epub 2010 Oct 20.

  6. Amnon Z. Laparoscopic nephroureterectomy: Is it always as good as open nephroureterectomy? Eur Urol. 2010; 58(5): 652-54.

  7. Assimos DG, Hall MC, Martin JH. Ureteroscopic management of patients with upper tract transitional cell carcinoma. Urol Clin North Am. 2000; 27(4):751-60.

  8. Soderdahl DW, et al. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. 2005; 23(2): 114-22.

  9. Favaretto RL, Shariat SF, Chade DC, Godoy G, Kaag M, Cronin AM et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol 2010; 58(5):645-51.

  10. Takahara K, Inamoto T, Komura K, Watsuji T, Azuma H. Post-operative urothelial recurrence in patients with upper urinary tract urothelial carcinoma managed by radical nephroureterectomy with an ipsilateral bladder cuff: Minimal prognostic impact in comparison with non-urothelial recurrence and other clinical indicators. Oncol Lett. 2013; 6(4):1015-1020.

  11. Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol 2010; 57: 963-9.

  12. Ariane MM, Colin P, Ouzzane A, Pignot G, Audouin M, Cornu JN et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol 2012; 19 (1): 301-8.

  13. Walton TJ, Novara G, Matsumoto K, Kassouf W, Fritsche HM, Artibani W et al. Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int. 2011; 108(3):406-12.

  14. Yang CK, Chung SD, Hung SF, Wu WC, Ou YC, Huang CY et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: the Taiwan Robot Urological Surgery Team (TRUST) experience. World J Sug Oncol. 2014. Jul 17; 12:219. doi: 10.1186/1477-7819-12-219.

  15. Rose K, Khan S, Godbole H, Olsburgh J, Dasgupta P; GUY'S and St. Thomas' Robotics Group. Robotic assisted retroperitoneoscopic nephroureterectomy - first experience and the hybrid port technique. Int J Clin Pract. 2006; 60(1):12-4.

  16. De Lorenzis E, Palumbo C, Cozzi G, Talso M, Marco Rosso, Costa B, et al. Robotics in uro-oncologic surgery. Ecancermedicalscience. 2013 Sep 26; 7:354. doi: 10.3332/ecancer.2013.354.

  17. Roupreˆt M, Babjuk M, Compe Eva, Zigeuner R, Sylvester R, Burger M et al. European guidelines on upper tract urothelial carcinomas: 2013 Update. Eur Urol. 2013; 63(6):1059-71.

  18. Rouprêt M, Smyth G, Irani J, Guy L, Davin JL, Saint F et al. Oncological risk of laparoscopic surgery in urothelial carcinomas. World J Urol. 2009; 27(1):81-8.

  19. RoupreˆtM. Is there currently enough evidence to assess whether laparoscopic nephroureterectomy is safe to treat urothelial carcinoma of the upper urinary tract? Eur Urol. 2012; 61(6):1154-5.

  20. Lughezzani G, Sun M, Perrotte P, Shariat SF, Jeldres C, Budaus L, et al. Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? Apopulation-based study. Eur Urol. 2010; 57(6):956-62.

  21. Li W-M, Shen J-T, Li C-C, Ke HL, Wei YC, Wu WJ, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010; 57(6):963-9.

  22. Kuroda K, Asakuma J, Horiguchi A, Tasaki S, Yoshii H, Sato A et al. Prognostic factors for upper urinary tract urothelial carcinoma after nephroureterectomy. Urol Int. 2012; 88(2):225-31.

  23. Phé V, Cussenot O, Bitker MO, Rouprêt M. Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU Int. 2011; 108(1):130-8.

  24. Gill IS, Soble JJ, Miller SD, Sung GT. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol. 1999; 161(2):430-4.

  25. Hanna N, Sun M, Trinh Q-D, Hansen J, Bianchi M, Montorsi F, et al. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol [Internet]. 2012 [citado 30 de junio de 2015];61(4):715-21.

  26. Waldert M, Remzi M, Klingler HC, Mueller L, Marberger M. The oncological results of laparoscopicnephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy. BJU Int. 2009; 103:66-70.

  27. Mueller TJ, Da Justa DG, Cha DY, Kim IY, Ankem MK. Ureteral fibrin sealant injection of the distal ureter during laparoscopic nephroureterectomy-a novel and simple modification of thepluck technique. Urology. 2010; 75(1): 187-92.

  28. Angulo JC, Hontoria J, Sanchez-Chapado M. One-incision nephroureterectomy endoscopically assisted by transurethral ureteral stripping. Urology. 1998; 52 (2): 203-7.

  29. Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol. 2008; 54(5):1127-35.

  30. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998; 52:594-601.

  31. Xylinasa E, Rinka M, Cha EK, Clozel T, Lee RK, Fajkovic H et al. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2014; 65(1):210-7.

  32. Greco F,Wagner S, Hoda R, Hamza A, Fornara P. Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up. BJU Int. 2009; 104: 1274-8.

  33. Micali S, Celia A, Bove P, et al. Tumor seeding in urological laparoscopy: an international survey. J Urol 2004; 171: 2151-4.

  34. Roscigno M, Brausi M, Heidenreich A, Lotan Y, Margulis V, Shariat SF et al. Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol. 2011; 60(4):776-83

  35. Stewart GD, Humphries KJ, Cutress ML, Riddick AC, McNeill SA, Tolley DA. Long-term comparative outcomes of open versus laparoscopic nephroureterectomy for upper urinary tract urothelial cell carcinoma after a median follow-up of 13 years. J Endourol. 2011; 25(8):1329-35.




2020     |     www.medigraphic.com